Services

Clinical Review and Safety: The Bottom Line on Program
Quality and Worker Health

Our clinical programs are geared toward safety and risk management.

• Retro Drug Utilization Review (DUR): Analyzes potential problems or fraud and abuse after the prescription is filled. This program provides reports to the client and, with the client’s approval, an informational letter encouraging the prescribing physician(s) to change prescribing patterns. Our Retro DUR program looks for duplicate therapy, high utilization of controlled substances, muscle relaxants and other drugs, and extended use of hypnotics (sleep medications).
• Independent Pharmacist Review: Review of an injured worker’s medication history by a licensed Express Scripts pharmacist. Our pharmacist evaluates appropriateness of dosages, possible duplication of therapy, potential drug interactions or other possible issues.
• Predictive Modeling: Designed to identify claims that represent increased risk for clients due to potentially inappropriate patterns of drug use. Clients may use these reports to help evaluate the need for such interventions as case management, independent medical examinations or physician, peer-to-peer conversations.