[Medicaid] Medicaid Drug Utilization Review (DUR) Program (CMS-R-153)
Revision of a currently approved collection
No
Regular
Comment filed on proposed rule and continue
03/19/2025
01/15/2025
OMB files this comment in accordance with 5 CFR 1320.11( c ). This OMB action is not an approval to conduct or sponsor an information collection under the Paperwork Reduction Act of 1995. This action has no effect on any current approvals.
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
12/31/2027
36 Months From Approved
12/31/2027
676
0
676
41,860
0
41,860
0
0
0
Section 4401 of the Omnibus Budget Reconciliation Act of 1990 and section 1927(d) of the Social Security Act requires States to provide for a Medicaid Drug Utilization Review (DUR) program for covered outpatient drugs. The DUR program is required to assure that prescriptions are appropriate, medically necessary and are not likely to result in adverse medical results. Each State DUR program must consist of prospective drug use review, retrospective drug use review, data assessment of drug use against predetermined standards, and ongoing educational outreach activities. In addition, States are required to submit an annual DUR program report that includes a description of the nature and scope of State DUR activities as outlined in the statute and regulations.
The Centers for Medicare and Medicaid Services, Center for Medicaid, CHIP and Survey and Certification, is requesting a 3-year approval of the State data collection requirements, the CMS forms CMS-R-153, CMS-R-153a, CMS-R-153b, and CMS-R-153c data collection instruments with instructions and the annual reporting contained in the Medicaid Drug Utilization Review regulation.
This iteration is associated with our December 10, 2024 (89 FR 99340) proposed rule (CMS-4208-P, RIN 0938-AV40) regarding Part D coverage of anti-obesity medications (§ 423.100) and its application to the Medicaid program. There will be a burden for the state Medicaid programs that do not already cover AOMs when used for weight reduction or chronic weight management for Medicaid enrollees with obesity to modify their existing coverage and reimbursement policies and criteria to remove such exclusion of AOMs.
Overall, this iteration would impact 39 States and add a one-time burden of 39 responses, 1,560 hours, and $66,846. See section 15 of the Supporting Statement for details
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CMS-R-153 Abbreviated MCO Surveys
CMS-R-153 - Supporting Statement A (CMS-4208-P version 4).docx
Medicaid Drug Ulilization Review (DUR) Annual Report (42 CFR 456.712 and 438.3)