The Quality Assurance (QA) program is made up of utilization management systems and review processes designed to help ensure safe and appropriate use of prescription drugs covered under Medicare Part D. The program’s focus is on reducing adverse drug events and drug interactions, optimizing medication utilization, and providing incentives to reduce costs when medically appropriate. Farm Bureau Health Plans offers the QA program at no additional cost to its members and their providers.
Utilization management tools are used to encourage appropriate and cost-effective use of Medicare Part D prescription drugs. These tools include, but are not limited to, prior authorization, clinical edits, quantity limits, and step therapy.
Drug Utilization Reviews
As part of the QA program, all prescriptions are screened by drug utilization review systems to detect and address the following issues:
- Significant drug interactions
- Duplication of treatment
- Appropriate use of generic medications
- Inappropriate or incorrect drug dosing
- Patient-specific drug contraindications and allergies
- Over-utilization and under-utilization
- Abuse or misuse
Under the QA program, prescription drugs are reviewed before they are dispensed. This is called a concurrent drug utilization review (DUR).
In addition, we perform ongoing, periodic reviews of claims data to evaluate prescribing patterns and drug utilization that may suggest potentially inappropriate use. This is called retrospective drug utilization reviews (RDUR).