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What is CMS position regarding utilization review?

April 26, 2017CMS position review utilization

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What is CMS position regarding utilization review?

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A81. Where submitters furnish utilization review reports indicating that a Claimant should be taking none, fewer, different, or less frequent drugs, this evidence will be considered by CMS. Reports of actual drug use from treating physicians will be given more weight than utilization review reports. Q82. What is CMS’ position regarding multiple drug manufacturers> A82. Brand name drugs are only available from one manufacturer, whereas generic drugs are available from multiple manufacturers.