New Prescription Safety Edits

To help increase patient safety and prevent abuse and fraudulent activity, UnitedHealthcare Community Plan is continuing to implement Concurrent Drug Utilization Review (cDUR) safety edits.

How it works

  1. At the point of sale, the pharmacist will be alerted of a drug-drug interaction, therapeutic duplication or high dose.
  2. The pharmacist will then look at the member’s profile and contact the prescriber or member to determine if the member should receive both prescriptions.
  3. If the pharmacist determines the prescription should be processed, they can override the alert by entering the appropriate reason codes.
  4. Pharmacies will receive a fax explaining these safety edits and what action needs to be taken to override them.

Safety edits will be implemented on Aug. 1, 2020 in the pharmacy systems to review the member’s current medications for the following:

  • Therapeutic Duplication: Identifies potential duplications to prevent members from taking more than one drug in the same drug class.
  • Therdose (High Dose): Identifies potential instances where a member could be exceeding the Food and Drug Administration’s approved maximum dose.
  • Drug-Drug Interaction: Identifies potential instances where a member could be utilizing two drugs with an identified drug-interaction flag in Medi-Span.

The following drug classes and cDUR edits will be added to the UnitedHealthcare Community Plan:


cDUR Edit:
Drug–Drug Interaction

Drug Class:
QTc Prolonging Agents 

States in Scope:
AZ, CA, FL, HI, KS, LA, MD, MI, MS, NE, NJ, NV, NY, OH, PA, RI, TX, VA, WA


cDUR Edit:
Therdose

Drug Class:
Antidepressants 

States in Scope:
AZ, CA, FL, HI, KS, LA, MS, NE, NJ, NV, NY, OH, PA, RI, TX, VA, WA (ages 18 and older)


cDUR Edit:
Therapeutic Duplication

Drug Class:
Buprenorphine Products

States in Scope:

AZ, CA, FL, HI, KS, LA, MD, MI, MS, NE, NJ, NV, NY, OH, PA, RI, TX, VA, WA


cDUR Edit:
Therapeutic Duplication

Drug Class:
Muscle Relaxants

States in Scope:

AZ, CA, FL, HI, KS, LA, MD, MI, MS, NE, NJ, NV, NY, OH, PA, RI, TX, VA, WA


cDUR Edit:
Therapeutic Duplication

Drug Class:
Non-sedating Antihistamines

States in Scope:
AZ, CA, FL, HI, KS, LA, MD, MI, MS, NE, NJ, NV, NY, OH, PA, RI, TX, VA, WA


cDUR Edit:
Therapeutic Duplication

Drug Class:
Testosterone Products 

States in Scope:
AZ, CA, FL, HI, KS, LA, MD, MI, MS, NE, NJ, NV, NY, OH, PA, RI, TX, VA, WA