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Drug Utilization Management


WellCare requires participating pharmacies to perform a drug utilization review (DUR). This review analyzes 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
  • 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 drug usage criteria meet and satisfy FDA guidelines. The review also ensures our plan’s Pharmacy and Therapeutic Committee and First Data Bank Criteria adopt clinical protocols. 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. WellCare also partners with state Quality Improvement Organizations (QIO) that are contracted with Medicare to collect, analyze, and report data based on medication therapy practices.

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Y0070_WCM_64252E Last Updated On: 10/1/2020
WellCare will be performing maintenance on Saturday, September 18, 2021 at 6pm EST until Sunday, September 19, 2021 at 6am EST. You might not be able to access systems or fax during this time. We are sorry for any issues this may cause. Thank you for your patience. If you need assistance, contact us. ×