Drug Utilization Management

We conduct drug use reviews for our members to help make sure that they are getting safe and appropriate care. These reviews are especially important for members who have more than one provider who prescribes their drugs.

IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) has a process in place to identify and reduce medication errors. We do a review each time you fill a prescription. We also review our records on a regular basis. During these reviews, we look for potential problems such as:

  • Possible medication errors.
  • Drugs that may not be necessary because you are taking another drug to treat the same medical condition.
  • Drugs that may not be safe or appropriate because of your age or gender.
  • Certain combinations of drugs that could harm you if taken at the same time.
  • Prescriptions written for drugs that have ingredients you are allergic to.
  • Possible errors in the amount (dosage) or duration of a drug you are taking.
  • Over-utilization and under-utilization
  • Clinical abuse/misuse

If we see a possible problem in your use of medications, we will work with your Doctor to correct the problem. IEHP DualChoice also provides information to the Centers for Medicare and Medicaid Services (CMS) regarding its quality assurance measures according to the guidelines specified by CMS.

IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

Information on this page is current as of October 15, 2018.
H5355_CMC_19_1059755 Accepted