Drug Utilization Management and Quality Assurance

WellCare helps to ensure the safety of its members and their health through quality assurance systems and programs to reduce medication errors and adverse drug interactions. Some of these programs may have limited eligibility criteria, and are not considered a benefit. Please contact WellCare for additional information.

Drug Utilization Management

WellCare requires participating pharmacies to perform a Drug Utilization Review (DUR) before a member receives their prescription. This is designed to analyze drug safety and usage for members based on their medication profile. The DUR is an important tool that screens online real-time interactions such as:
 

• Drug-Drug Interactions
• Drug-Disease
• Drug-Age Precautions
• Drug-Gender Precautions
• Incorrect Dosage Precautions
• Incorrect Duration of Drug Therapy
• Therapeutic Duplication
• Excessive Use Precautions
• Prescription Limitations
• Compliance Monitoring

The drug utilization review serves as a measure to ensure that drug usage criteria are met and satisfy FDA guidelines, and clinical protocols as adopted by our plan’s Pharmacy and Therapeutic Committee, and First Data Bank Criteria. Based on this review, the attending pharmacist and/or physician can make the most beneficial decision to the patient involving their pharmaceutical care. Review the Evidence of Coverage and learn more about WellCare Quality Assurance and Drug Utilization Management.

Quality Assurance

WellCare ensures the safety and health of its members through the establishment of effective Quality Assurance measures and systems. We do this to reduce medication errors and adverse drug reactions, and improve medication utilization. These measures include making sure that providers comply with pharmacy practice standards, drug utilization review, internal medication error identification systems, medical therapy management programs, and pharmacy and therapeutics committees. WellCare also partners with state Quality Improvement Organizations (QIO) that are contracted with Medicare to collect, analyze, and report data based on medication therapy practices. Review the Evidence of Coverage and learn more about WellCare Quality Assurance and Drug Utilization Management.