The Drug Utilization Review program is an innovative, computerized system, developed in-house to track, flag and report on prescription drugs that require more scrutiny and thus avoid fraud, dangerous interactions and over-prescribing. This review also enables significant savings for both the member and the payer. Utilization review services include Prior Authorizations, reviewing of set quantity limitations and application of step therapy program.

All exception requests are processed within a standard time period of 48 hours and expedited requests are processed within 24 hours. Our decision of approval or denial is sent to the prescribing physician and pharmacist. We also perform Medication Therapy Management Reviews for eligible members through our clients.

Utilization Management is the evaluation of the appropriateness, medical need and efficiency of health care services procedures and facilities according to established criteria or guidelines and under the provisions of an applicable health benefits plan. Typically it includes new activities or decisions based upon the analysis of a case.