What can be a reason for receiving a DUR reject from insurance?

Receiving a drug utilization review (DUR) reject from insurance often occurs when there is a concern regarding the appropriateness of medication use. One common reason for this is refilling medication too soon. Insurance companies utilize DUR processes to monitor prescriptions for potential issues like early refills, which may indicate misuse, overuse, or non-adherence to prescribed therapy. If a patient seeks to refill a medication before the expected time, it raises a red flag for the insurer, prompting the DUR reject as a protective measure to ensure patient safety and appropriate medication management.

In contrast, while factors like low price points, repackaging of medications, or changes in insurance policies may affect billing or claims in different scenarios, they are typically not direct triggers for a DUR reject. These issues pertain more to administrative processes or pricing strategies rather than clinical appropriateness, making them less relevant in the context of why a DUR reject would occur.