Orange County NC Website
Browse       Search
DocuSign Envelope ID:E8C538EF-9595-4E36-A4C9-2CA66C7BE34A <br /> CLINICAL PROGRAMS EXHIBIT <br /> Envision shall provide the following Clinical Programs to Plan Sponsor: <br /> Standard Cost Reduction Services (included in Administrative Fee) <br /> Concurrent Drug Utilization Review ("DUR") Program — point of sale system checks to <br /> identify contraindicated drugs and drug strengths not recommended <br /> Envision's Concurrent DUR Program provides electronic clinical monitoring of prescription <br /> drugs at the point-of-sale claims system edits. It is designed to encourage cost-effective, high <br /> quality drug therapies by notifying pharmacists of potential drug therapy complications at the <br /> point-of-sale before prescriptions are dispensed. The DUR Program is intended to be used by the <br /> pharmacist as a screening tool to detect outlying prescription drug utilization patterns, but not <br /> substitute for professional judgment. <br /> All claims submitted through the Envision Concurrent DUR Program are entered into the <br /> patient's active drug profile, thus allowing the system to evaluate prescription claims prior to the <br /> initiation of drug therapy. The patient's profile is accessed regardless of the participating <br /> pharmacy the patient may choose. <br /> Drug Utilization Review <br /> Listed below are the eleven major Concurrent DUR modules that Envision utilizes during the <br /> processing of prescription drug claims. All of the clinical modules use National Council of <br /> Prescription Drug Plans ("NCPDP") standard conflict codes: <br /> • Duplicate Therapy(drugs from the same therapeutic class) <br /> • Drug-Drug Interaction(combinations of drugs with potential for severe adverse effects) <br /> • Low Dose Alert (drug doses that fail to meet the suggested minimum daily dose) <br /> • High Dose Alert (drug doses that exceed the suggested maximum daily dose) <br /> • Excessive Utilization ("Too Soon Refill" Monitoring which monitors refill claims sent <br /> before a defined percentage of the previous fill is used) <br /> • Geriatric Precautions (drugs inappropriate for patients over the age of 60) <br /> • Pediatric Precautions (drugs inappropriate for pediatrics based on the patient's tender age) <br /> • Drug Duplication(drugs containing the same ingredients) <br /> • Drug-Gender Precaution(drugs not indicated for a specific gender) <br /> • Drug-Disease Precaution(drugs inappropriate) <br /> • Under-Utilization (Late Refill Monitoring which is a refill for a chronic maintenance drug <br /> requested at an interval longer than directed by the prescriber) <br /> Each DUR warning is accompanied by the appropriate NCPDP DUR conflict code and message. <br /> The message received will be in a format designed by the pharmacy software vendor. <br /> Additionally, most pharmacy software may also have editing capability, but may be limited to <br /> prescriptions filled at that store or chain. <br /> \Pass-through PBMSA(041917) ©Envision Pharmaceutical Services,LLC Page 34 of 41 <br />