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 Feb. 1, 2021, 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
  • Drug-drug interaction: Identifies potential instances where a member could be utilizing two drugs with an identified drug-interaction flag in Medispan

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

cDUR edit: Drug-drug interaction
Drug class: 
Opioids and sedatives
States in scope:  AZ, CA, CO, FL, HI, KS, KY, LA, MD, MI, MS, NE, NJ, NV, NY, OH, PA, RI, TX, VA, WA

cDUR edit: Drug-drug interaction
Drug class: 
Ergots and triptans
States in scope:  AZ, CA, CO, FL, HI, KS, KY, LA, MD, MI, MS, NE, NJ, NV, NY, OH, PA, RI, TX, VA, WA

cDUR edit: Therapeutic duplication
Drug class: 
Calcium channel blockers
States in scope:  AZ, CA, CO, FL, HI, KS, KY, LA, MD, MI, MS, NE, NJ, NV, NY, OH, PA, RI, TX, VA, WA

cDUR edit: Therapeutic duplication
Drug class: 
Gabapentinoids
States in scope:  AZ, CA, CO, FL, HI, KS, KY, LA, MD, MI, MS, NE, NJ, NV, NY, OH, PA, RI, TX, VA, WA

cDUR edit: Therapeutic duplication
Drug class: 
MS immunomodulators
States in scope:  AZ, CA, CO, FL, HI, KS, KY, LA, MD, MI, MS, NE, NJ, NV, NY, OH, PA, RI, TX, VA, WA