Medication (Drug) Management and Safety
Our medication management and safety programs are designed to help improve your health outcomes and reduce the risk of adverse drug reactions. These programs also help ensure that your doctor and pharmacy are aware of any potential issues with the medications you take to support your overall well-being.
Drug Adherence
Filling your prescriptions on time and taking your medications as directed by your doctor is an important part of staying healthy. Missing doses or not taking your medications as prescribed can cause your health to worsen. The following tips can help you stay on track:
- Ask your doctor to write a prescription for a 90- to 100-day supply of your medication.
- Ask your pharmacy whether it offers 90- to 100-day supplies, synchronized prescription refills, or home delivery. Visit our Find a Provider/Pharmacy tool to locate pharmacies in your area that offer these services.
- Ask your pharmacy about automatic prescription refills.
- If you take maintenance medications regularly, consider enrolling in our Mail Order Service .
- Use a pill organizer to help remind you when it is time to take your medications.
If you need assistance obtaining or organizing your medications, please contact Member Services.
Drug Utilization Review (DUR) Program
Our Drug Utilization Review (DUR) Program reviews your current and past prescription medications. When your pharmacy submits a prescription for coverage, we review it for:
- Age-related concerns
- Gender-related concerns
- Overuse or underuse of medications
- Potential interactions with other medications
- Potential issues related to existing medical conditions
- Incorrect dosage
- Incorrect duration of therapy
- Drug and allergy interactions
- Potential abuse or misuse
Based on this review, you, your doctor, and your pharmacist can make informed decisions regarding your care.
For more information about our Drug Utilization Review Program, please contact Member Services.
Drug Management Program
Our Drug Management Program promotes the safe and effective use of opioid medications, including oxycodone (OxyContin®), hydrocodone (Vicodin®), morphine, and codeine.
Opioid medications can help relieve certain types of pain following an injury or surgery. However, they also carry serious risks, including addiction, overdose, and death. These risks increase when opioids are taken in high doses or with certain other medications, such as benzodiazepines (Xanax®, Valium®, or Klonopin®) used to treat anxiety or sleep disorders.
The goal of this program is to help you, your doctor, and your pharmacy work together to ensure opioid medications are prescribed appropriately and used safely.
Pharmacy Reviews
Each time you fill an opioid prescription, your pharmacist reviews your medication history to identify:
- Potentially unsafe opioid quantities
- Potential interactions with other medications, including benzodiazepines
New opioid prescriptions may be limited to a seven-day supply or less. This limit does not apply if you are already receiving opioid therapy.
If your prescription cannot be filled, your pharmacy will provide information about requesting a coverage determination. If your health requires an urgent decision, you may request an expedited coverage determination. You may also request a formulary exception before filling your prescription.
How the Program Works
If you receive opioid prescriptions from more than one doctor, we may work with your providers to determine whether the medication is medically necessary and being used safely.
If we determine that your opioid use may not be safe, we may limit your coverage. For example, we may require you to receive opioid prescriptions from certain providers or use specific pharmacies to better coordinate your care.
Before placing you in the Drug Management Program, we will send you a letter explaining our review of your prescription history. You will have an opportunity to tell us which doctors or pharmacies you prefer to use.
If we decide to limit your coverage, we will send another letter explaining your appeal rights and the steps you and your doctor can take.
This program does not apply if you:
- Have cancer
- Have sickle cell disease
- Receive hospice, palliative, or end-of-life care
- Live in a long-term care facility
Your Doctor Can Help
Talk with your doctor about all of your pain management options. Together, you can decide which treatments are most appropriate for you. Other medications or non-drug therapies may help manage pain while reducing the risks associated with opioid medications.
If you have questions about our Drug Management Program, please contact Member Services.
Additional Resources
Learn more about safe and effective pain management through the following resources: