Drug Utilization Management

WellCare requires participating pharmacies to perform drug utilization review (DUR). This is designed to analyze drug safety and usage for members based on their profile. The DUR is an important tool that screens on-line real time interactions such as:

• Drug-Drug Interactions
• Drug-Disease
• Drug-Age precautions
• Drug-Gender precautions
• Drug-Pregnancy precautions
• Drug-Allergy precautions
• Incorrect dosage precautions
• Incorrect duration of drug therapy
• Therapeutic duplication
• Excessive use precautions
• Prescription limitations
• Compliance monitoring

The drug utilization review serves as a measure to ensure that drug usage criteria are met and satisfy FDA guidelines, clinical protocols are adopted by our plan’s Pharmacy and Therapeutic Committee, and First Data Bank Criteria. Based on this review, the attending pharmacist and/or physician can make the most beneficial decision to the patient involving their pharmaceutical care.

Quality Assurance

WellCare ensures the safety and health of its members through the establishment of effective Quality Assurance measures and systems. We do this to reduce medication errors and adverse drug reactions, and improve medication utilization. These measures include making sure that providers comply with pharmacy practice standards, drug utilization review, internal medication error identification systems, medical therapy management programs, and pharmacy and therapeutics committees. 'Ohana also partners with state Quality Improvement Organizations (QIO),that are contracted with Medicare to collect, analyze, and report data based on medication therapy practices.