Drug utilization review program
Optum Specialty Pharmacy offers the following two utilization management programs to monitor for and quickly address unsafe or inappropriate prescriptions for plan participants.
Concurrent Drug Utilization Review
This process automatically scans each prescription entered by using a direct administration tool linking to plan pharmacists’ computers. Before dispensing, pharmacists receive a message warning of potential safety issues given the drug requested and the patient’s drug history. A rejection notification can also be sent if the prescription does not meet certain criteria.
Safety issues that can be flagged include:
- drug interactions
- medical condition interactions
- gender or age conflicts
- therapeutic duplications
- dosage amounts
- excessive duration
- early refill
Retrospective Drug Utilization Review
An enhancement to the concurrent drug utilization review, this program continually reviews plan participant prescription drug usage, checking for patterns that may infer inappropriate use or overuse of certain medications or drug types.