Drug Utilization Review
With the rapid proliferation of new drug treatments,
Pharmacy Benefit Managers and health insurance payers are under
pressure to manage escalating costs, while ensuring their subscribers
receive the drug benefits they deserve. Drug utilization review (DUR)
is an important component of any payer’s cost containment initiatives,
but must ensure the integrity of services to its members.
AllMed
provides independent drug review services to leading PBMs that help
them to achieve this goal, by providing an objective, evidence-based
solution. Our drug review services plug seamlessly into your claims
and drug utilization review workflow, allowing you to make member drug
benefit determinations with fairness, objectivity, accuracy and
timeliness.
AllMed’s staff of in-house physicians perform all
drug benefit reviews, by reviewing case records, applying your
formulary and the latest clinical evidence to make an objective
determination of coverage. Our standards-based review services provide
the confidence to your members that they are receiving an objective
review of their benefits, and ensures the integrity of your services.
AllMed’s pharmacy review services include:
- Prior authorizations
- Medical necessity of drug therapy
- Drug coverage determinations
- Review of tiered drug therapies
- Review of step therapy drugs
- Review of drug dosage and quantity limits
- Medicare Part D coverage determination and re-determinations
- Coverage Determination Request Forms
- Medicare Exception Requests
- Medicaid drug review
- Private insurance drug review
