The Incorrect Dosage screening system alerts pharmacists when doses for certain prescribed target drugs fall outside the normal adult or pediatric dosage range. Adult recipients are defined as people 18 years and over. Pediatric recipients are under the age of 18 years. Recipient-specific information is not required since dose ranges are based on standardized weights for various age groups with normal hepatic and renal function. No geriatric dosing standards (for ages 65 years and older) are included in the incorrect dosage warning screen at the present time. This Alert can be pre-overridden.
Incorrect duration of drug therapy occurs when the number of days of prescribed therapy exceeds or falls short of the recommendations contained in the predetermined criteria and standards. This involves primarily antibiotics prescribed for irregular periods of time. Antibiotics used chronically in prophylaxis or dermatological treatments are excluded. This Alert can be pre-overridd
DRUG AGE CONFLICT
The Drug-Pediatric and Drug-Geriatric screening systems check for inappropriate use of select target drugs for specific age ranges. Pediatric conflicts pertain to patients age 18 years and under; geriatric conflicts pertain to patients age 65 years and over. Can be pre-overridden in the same pharmacy that filled the drug claim in conflict
The Drug Interaction Alert screens only for significant (Severity Level 1) interactions between the drug in a new prescription and drugs currently active on the patient's profile. This screen accounts for serum half-life when editing for active medications in the patient’s paid claims medication history. Unlike other alerts, this alert is not confined to a target drug list but includes all drugs on the Formulary File.
Therapeutic duplication occurs when a patient receives two or more drugs from the same therapeutic or pharmacologic class such that the combined daily dose increases the risk of an adverse medical result or incurs additional program costs without additional therapeutic benefit. Can be pre-overridden by the same pharmacy that processed the drug claim in conflict.
Ingredient Duplication occurs when a patient receives two or more prescriptions containing the same active chemical compound. Can be pre-overridden in the same pharmacy that the drug claim in conflict was filled.
The Early Refill (or Overutilization) Alert screen warns the pharmacist of early refills and/or potential abuse situations. This screen identifies a subsequent prescription submitted for the same target drug when the patient’s medication paid claims history shows greater than 25 percent of the previously dispensed prescription days supply remains. Can be pre-overridden in the same pharmacy as the drug claim in conflict.
The Late Refill (or Underutilization) Alert screen creates warnings when subtherapeutic patterns of prescription use are detected. Alerts are generated when patients fail to renew prescriptions for select maintenance-use target drugs on a timely basis. Pharmacists are notified when the renewal request interval is greater than 125 percent of the previous prescription’s days supply. This Alert can be pre-overridden.
The Clinical Misuse/Additive Toxicity screening system warns pharmacists when the number of active prescriptions for select drugs in previously defined therapeutic classes for a single patient exceed a specified threshold. Currently this occurs when a new prescription drug has overlaping Central Nervous System effects with at least 3 other drugs active on the patient's profile
The Drug-Disease screening system alerts pharmacists when certain target drugs are prescribed for patients with existing medical conditions. ICD-9 diagnosis codes from medical and hospital claims data are used to detect diseases that may be aggravated or altered by the prescribed target drug. Diseases are classified as either short term (remain active in patient history for 110 days) or long term (remain active indefinitely). Disease durations are determined by consensus of the DUR Board
The Drug-Allergy screening system utilizes patient-specific allergy information (ICD 9 "E" codes from medical and hospital claims) to alert pharmacists when newly submitted drug claims contain ingredients which have a significant potential to cause an allergic reaction. This Alert can be pre-overridden
Alerts for target drugs in pregnancy categories D or X are transmitted to the pharmacist. The presence of pregnancy is determined by ICD-9 codes from the patient medical claim history as well as prescription claim history for prenatal vitamins. This Alert can be pre-overridden