OBRA 90, Medicare, PPPA and Other Federal Acts

The Omnibus Budget Reconciliation Act of 1990 (OBRA ’90)

The Omnibus Budget Reconciliation Act of 1990 (OBRA ’90) fundamentally reshaped pharmacy practice by establishing standards for patient care and medication safety. Congress originally enacted OBRA ’90 to mandate prospective Drug Utilization Review (DUR) for Medicaid outpatients. Recognizing the clear clinical benefits of these safety checks, many states have since extended OBRA ’90-style prospective DUR and patient counseling requirements to all pharmacy patients, reaching well beyond Medicaid beneficiaries.

A prospective DUR is a vital safety screen conducted prior to dispensing a prescription to identify potential drug-related problems before the medication reaches the patient. During this process, screening systems and pharmacy staff evaluate prescriptions for therapeutic duplication, drug-disease contraindications, and drug-drug interactions. Prospective DUR screenings also evaluate prescriptions for incorrect drug dosage, inappropriate duration of treatment, and drug-allergy interactions. As a pharmacy technician entering prescription data, you may flag DUR alerts that appear on your computer terminal and gather background information. However, clinical assessment, clinical judgment, and the resolution of these clinical alerts belong solely to the supervising pharmacist.

Under OBRA ’90, pharmacies must offer Medicaid outpatients or their caregivers an opportunity to receive counseling from a pharmacist about their prescriptions. Pharmacy technicians play a vital communication role by asking a patient if they would like to speak with the pharmacist, but technicians cannot conduct patient counseling. Medication counseling must be performed by a licensed pharmacist or, where state law permits, a pharmacy intern practicing under pharmacist supervision. Patients possess the legal right to refuse medication counseling offered by the pharmacy. When a patient declines this service, the technician or pharmacist must document the patient's refusal of medication counseling as required by state law and pharmacy policy.

To support safe medication use, OBRA ’90 requires pharmacies to make a reasonable effort to maintain medication profiles for Medicaid outpatients. Technicians assist in keeping these records complete by collecting and inputting demographic and clinical details. Patient profiles should record available demographic information, including the patient’s name, address, telephone number, age or date of birth, and sex. Profiles must also record available clinical information, such as known allergies, drug reactions, relevant medical conditions, and comprehensive medication history. While prospective DUR occurs before dispensing at the pharmacy counter, retrospective DUR involves an ongoing post-dispensing review of claims data conducted by state agencies or health plans to identify broader patterns of fraud, abuse, or inappropriate prescribing across healthcare systems.