Drug utilization review program - Chapter 8, 2021 UnitedHealthcare Administrative Guide

We conduct drug utilization reviews to help ensure members are getting safe and appropriate care. These reviews are especially important for members who have more than one doctor prescribing their medications.

We review member drug utilization each time members fill a prescription and also by regularly reviewing our records. We look for medication problems such as:

  • Possible medication errors;
  • Duplicate drugs that are unnecessary because the member is taking another drug to treat the same medical condition;
  • Drugs that are inappropriate because of age;
  • Possible harmful interactions between drugs;
  • Drug allergies; or
  • Drug dosage errors.

If we identify any problems, we share our findings with you and discuss other alternatives. You may receive calls or faxes from our pharmacy department following up on findings. If you have questions, contact the pharmacy department.