Prescription Drug Utilization Review

To help ensure that the quantity and dosage of your medications remain consistent with manufacturer, clinical, and the Food & Drug Administration (FDA) recommendations, we maintain a list of medications subject to Quality Care Dosing (QCD). When you fill a prescription for a medication subject to QCD, your prescription is reviewed for:


Dose Consolidation – Dose Consolidation checks to see whether you're taking two or more daily doses of medicine that could be replaced with one daily dose providing the same total amount of medication. Dose Consolidation advantages include making it more convenient for you to take your medication (you take fewer pills, instead of several doses or pills daily), and helping control overall pharmacy costs.


Recommended Monthly Dosing Level – This process checks to see that your monthly dosage of medication is consistent with both the manufacturer's and the FDA's monthly dosing recommendations and clinical information. Your doctor can also apply for an exception to QCD guidelines when medically necessary.


Additional prescription safety and quality measures include:


Express Scripts®'', Inc., Medication Alert – Express Scripts, Inc. (ESI) is the prescription mail-order service provider for our Medicare Advantage and Medex®' plans with prescription coverage. When you fill a mail-order prescription, ESI will electronically review it against your previous or current prescriptions. If safety issues are detected, ESI will send an alert to the retail or mail-order pharmacy filling your prescriptions.