mtf resource guide - express scripts · 2018-11-27 · beneficiaries placed in the pmp by their...
TRANSCRIPT
© 2018 Express Scripts. TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.
MTF RESOURCE GUIDE TRICARE PHARMACY BENEFIT
OCTOBER 2018
For internal MTF use during Tpharm 4 Contract.
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Contents
1. Express Scripts Federal Pharmacy Services® ............................................................................................. 3
2. Contact Information ....................................................................................................................................... 3
3. Clinical Services ............................................................................................................................................. 4
Deployment Prescription Program (DPP)......................................................................................................... 4
Other Overseas Distribution Channels ................................................................................................. 4
Formulary Search Tool (FST) ............................................................................................................................. 5
Prescription Monitoring Program (PMP) ......................................................................................................... 5
Transfer of Prescriptions ................................................................................................................................... 6
a. Transfer from MTF to Home Delivery ............................................................................................... 6 b. Transfer from Retail to TRICARE Pharmacy Home Delivery or MTF ................................................. 6 c. Transfer from TRICARE Pharmacy Home Delivery to MTF ............................................................... 7 d. Transfer of prescriptions for Controlled Substances ........................................................................ 7
4. Electronic Capabilities .................................................................................................................................. 7
Electronic Prior Authorization (ePA) ................................................................................................................. 7
Electronic Prescribing (eRX) ............................................................................................................................. 7
MTF Provider Portal ............................................................................................................................................ 8
5. CHCS and Claims Adjudication ..................................................................................................................... 9
NDC missing or invalid .................................................................................................................... 10
Compound did not come through correctly ................................................................................... 10
Date dispensed is earlier than date written ................................................................................... 10
Day supply is missing ...................................................................................................................... 10
Metric quantity is incorrect ............................................................................................................ 10
6. Resources Available..................................................................................................................................... 12
7. Glossary of Programs and Terms ................................................................................................................ 13
8. Comparison of DUR Messaging .................................................................................................................. 16
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1. Express Scripts Federal Pharmacy Services®
Express Scripts Federal Pharmacy Services is the division within Express Scripts responsible for managing the TPharm4 contract and the adjudication of prescription claims for TRICARE® beneficiaries. Within the division, a team of skilled individuals is dedicated to support the MTFs worldwide.
2. Contact Information
For MTF Pharmacies
Help Desk 24/7 855.315.1921
Fax for prescription transfers 877.895.1900
Email for general inquiries [email protected]
Help Desk 24/7 855.315.1921
Fax for prescriptions 877.895.1900
Email for general inquiries [email protected]
For MTF Provider Offices
Online Portal for PAs - CompletePA www.surescripts.com
Help Desk for CompletePA 866.797.3239
Online Portal for PAs - Cover My Meds www.covermymeds.com
Help Desk for Cover My Meds 866.452.5017
Fax to submit prior authorizations 866.684.4477
Help Desk to call in prior authorizations 866.684.4488
For Beneficiaries Help Desk 24/7 877.363.1303
Express Scripts Website www.express-scripts.com/TRICARE
TRICARE website www.tricare.mil
Address for prescriptions and claims Express Scripts, Inc. PO Box 52132 Phoenix, AZ 85082
Italy 00+800+3631-3030
Japan - IDC 0061+800-3631-3030
Japan - Telecom 0041+800-3631-3030
International Toll-Free
Helpdesks Japan - KDD 010+800-3631-3030
Japan - Other 0033+800-3631-3030
South Korea 002+800-3631-3030
Turkey
0811-288-001 (dial 877-363-1303 when prompted)
United Kingdom 00+800-3631-3030
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3. Clinical Services
Deployment Prescription Program (DPP) https://www.express-scripts.com/TRICARE/tools/deployedrx.shtml
Although Express Scripts primary points of services are located within the United States, the TRICARE pharmacy benefit also includes programs to ensure beneficiaries stationed overseas and in theater have access to necessary medications.
The Deployment Prescription Program (DPP) is the prescription program used by service members who are deployed overseas. To enroll, a “DPP Prescription form” (DPP Rx form) will be submitted to Express Scripts on behalf of the service member by the pre-deployment site. Each DPP Rx form must include an active e-mail address accessible while the service member is deployed and a valid in theater shipping address. The form can be filled out electronically (preferred) or by hand (print clearly, use dark ink).
DPP Guide for MTFs:
https://www.express-scripts.com/TRICARE/tools/DoD_Deployment_Prescription_Program_Provider_Brochure.pdf
DPP Brochure for Beneficiaries:
https://www.express-scripts.com/TRICARE/tools/DoD_Deployment_Prescription_Program_Beneficiary_Brochure.pdf
For more information, contact [email protected]
Other Overseas Distribution Channels
For beneficiaries not enrolled in DPP, prescriptions can be obtained through any MTF pharmacy located abroad. Outside the United States and U.S. Territories, you can only use TRICARE Pharmacy Home Delivery if you have an APO/FPO address or are assigned to a U.S. Embassy or Consulate and do not have other health insurance (OHI) with a pharmacy benefit. You must have a prescription from a U.S. licensed provider. Beneficiaries residing in Germany cannot use the Home Delivery option due to country specific Standard Operating Forces Agreement (SOFA) restrictions. These prescriptions can be filled at MTF pharmacies or host nation pharmacies.
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Formulary Search Tool (FST) www.express-scripts.com/TRICAREformulary
The FST allows healthcare providers, pharmacy staff and beneficiaries to look up a medication. A search will yield the following information:
Generic equivalents or alternative medications
Required forms for prior authorization
Notes or quantity/days’ supply limitations for the medication
Beneficiary copayments
Information about the medication
End users may further refine their search utilizing the medication’s name (brand or generic name), strength and dosage form
Prescription Monitoring Program (PMP)
https://www.express-scripts.com/TRICARE/safety_savings/prescriptionMonitoringProgram.shtml
The Prescription Monitoring Program (PMP) is designed to identify potential unsafe behavior with regard to controlled medications and prevent or decrease the risk of overutilization by restriction implementation.
Express Scripts emails monthly and quarterly PMP reports to designated MTF points of contact. To request inclusion on that report, email [email protected]
The monthly reporting includes current restriction population, monthly activity and restriction compliance. The quarterly reporting includes candidates assigned to your site that are identified based on pre-determined criteria including utilization of controlled substances and/or other high-risk medications.
Identification & Enrollment
Express Scripts identifies PMP candidates for enrollment based on pre-determined criteria, including utilization patterns of controlled substances and/or other high risk medications.
Identified beneficiaries are submitted to the respective TRICARE Managed Care Support Contractor (MCSC) or the assigned Military Treatment Facility (MTF) to review prescription history in conjunction with medical history to determine enrollment.
Identification can also occur internally by the TRICARE MCSC or MTF.
Beneficiaries, at their own request (for example, in the case of identity theft) may enroll themselves. Beneficiaries with restrictions entered at their own request may disenroll from the program at any time and remove all restrictions.
Beneficiaries placed in the PMP by their MTF will be assigned an authorized provider and/or pharmacy by a program point of contact at their site. The PMP is used for enrollees in the Sole Provider Program.
Beneficiaries placed in the PMP by their TRICARE MCSC receive a letter from Express Scripts explaining how, and by when, to make their pharmacy, prescriber and hospital selections.
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Prior Authorization (PA)
Reference Guide: https://www.express-
scripts.com/TRICARE/tools/TRICARE_Prior_Autorization_Process_Reference_Sheet.pdf
A PA refers to the authorization that is required prior to medications being dispensed under
TRICARE coverage. The PA process is designed to ensure medications are cost-effective and used
appropriately.
A type of PA called a medical necessity form is used by a healthcare provider to request non-
formulary prescriptions for non-active duty beneficiaries, and have those medications available at
the formulary cost share at Home Delivery or retail points of service. It is also used to request non-
formulary medication for active duty beneficiaries at Home Delivery or retail points of service.
For questions, contact 866.684.4488.
Transfer of Prescriptions Standard Operating Procedure: https://www.express-scripts.com/TRICARE/tools/Home_Delivery_to_MTF_Manual_FAX_Transfer_Requests_SOP.pdf
MTFs and TRICARE Pharmacy Home Delivery are the most cost effective points of service for beneficiaries to obtain their prescriptions.
a. Transfer from MTF to Home Delivery
Fax: Prescriptions at the request of the beneficiary can be faxed using a prescription transfer form available through CHCS. This functionality can be set up at any CHCS site.
Phone: Prescriptions can be transferred by calling the MTF Help Desk at 855-315-1921.
Automated direct transfers of prescriptions through CHCS is limited to twelve sites that implemented the technology with DHA approval. It does require pharmacy intervention at the MTF.
b. Transfer from Retail to TRICARE Pharmacy Home Delivery or MTF
Retail pharmacies are the most expensive point of service to fill prescriptions for both the government and TRICARE beneficiaries.
The transfer from retail can be completed by the beneficiary’s provider. If the provider is a civilian provider, the prescription can be e-prescribed.
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c. Transfer from TRICARE Pharmacy Home Delivery to MTF
For these transfers, use the same SOP above:
To request prescriptions be transferred from Home Delivery to the MTF, follow the Fax Standard Operating Procedure above.
Fax: Complete transfer form and fax to 888-817-2092.
Phone: Prescriptions can be transferred by calling 855-315-1921.
d. Transfer of prescriptions for Controlled Substances
Schedule II medications require a hard copy prescription with an original prescriber signature to be mailed. Prescription must include beneficiary’s name, address, phone number, date of birth and sponsor ID. Mail to: Express Scripts, PO Box 52150, Phoenix AZ 85072-9954.
Schedule III-V medications can be faxed to Express Scripts at 1-877-895-1900 unless the state in which the prescriber practices has specific form requirements.
For questions, contact the Help Desk 24/7 at 855.315.1921.
4. Electronic Capabilities
Electronic Prior Authorization (ePA)
https://www.express-scripts.com/TRICARE/safety_savings/prescribing.shtml
Electronic Prior Authorization is a streamlined process to submit prior authorizations (PAs). It decreases turnaround time compared to the traditional phone and fax process. Two ePA Portals are available: www.covermymeds.com and www.surescripts.com
For more information, see the Prior Authorization Reference Guide: https://www.express-scripts.com/TRICARE/tools/TRICARE_Prior_Authorization_Process_Reference_Sheet.pdf
Electronic Prescribing (eRX)
https://www.express-scripts.com/TRICARE/safety_savings/prescribing.shtml
Electronic prescribing reduces prescribing errors and is available to Civilian Providers to use for prescriptions filled at MTFs, retail pharmacies and for Home Delivery. Providers in MTFs that have implemented MHS GENESIS (electronic health record) now have the capability to e-prescribe directly into Home Delivery, a feature that was not available before GENESIS.
Prior to e-prescribing to one point of service or another, providers should determine the availability of medications at each location. They can do so by looking up the medication on the TRICARE Formulary Search Tool located at www.express-scripts.com/TRICAREFormulary.
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MTF Provider Portal
This is a secure web portal that can be used to renew prescriptions currently filled at the TRICARE mail order pharmacy, reduce fax volume to renew prescriptions and respond to beneficiary requests for prescriptions to be transferred from MTF/retail pharmacy to Home Delivery. The Portal can be used to communicate that patients are under the care of another Provider to minimize potential disruption of therapy. Also, Trusted Agents (nurses and medical assistants) can take action on prescriptions before Providers submit for an efficient workflow.
For more information or to request a User Guide, contact [email protected].
MHS Genesis
The Department of Defense is migrating to a new commercial Electronic Health Record (EHR) known as MHS Genesis. The EHR is a product of a company called Cerner and is replacing the Composite Health Care System (CHCS) at Military Treatment Facilities (MTF) during a 3 to 5 year rollout period. Express Scripts is available to assist MTF pharmacies with migration to the new platform.
The DHA in association with Cerner and other DOD agencies will manage and control the migration of MTFs to MHS Genesis. Express Scripts will serve as a partner with DHA and Cerner in assisting MTF pharmacies with this transition. In advance of implementation Express Scripts will reach out and provide resources to assist each location with applying commercial pharmacy business practices to the DOD dispensing function. This includes resources associated with training and education on the overall TRICARE pharmacy benefit, guidance on how to manage the claims correction process and information on processing/seeking approvals of prior authorizations and medical necessity to support the dispensing process.
Unlike CHCS, when using MHS Genesis, claims are adjudicated based on commercial pharmacy standards. Certain rejection codes will require correction prior to medication being dispensed. Some corrections may be made at the MTF while others will require coordination with Express Scripts. As sites transition to MHS Genesis, training and education materials will be provided.
For questions or issues, [email protected]
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5. CHCS and Claims Adjudication
Claims adjudication is the process by which prescription data is sent from the MTF to Express Scripts allowing for drug utilization review prior to dispensing of the medication.
MTF claims undergo a drug utilization review (DUR) to identify potential health and safety concerns related to drug/age and drug/gender benefit design rules, as well as drug/drug interactions as evaluated against the patient's comprehensive prescription medication profile from all three points of service (mail, retail and MTF).
Unlike traditional TRICARE claims adjudicated at the mail and retail points of service, prescriptions initiating at an MTF do not undergo a Defense Enrollment Eligibility Reporting System (DEERS) eligibility check. Additionally, copays are not calculated or assessed, other health insurance (OHI) is not enforced, and coordination of benefits (COB) processing is not enabled.
Eligibility for Home Delivery
TRICARE beneficiaries who have other health insurance (OHI) with a prescription plan, including Medicare Part D, are not eligible to use Home Delivery unless:
OHI does not include a pharmacy benefit;
The medication is not covered by OHI; or
OHI’s benefit maximum coverage limit was met.
Clinical Reviews and Claims Corrections
Express Scripts provides a host of processes and programs to enhance clinical safety and satisfaction. Although all MTF claims will continue through the adjudication process regardless of possible safety protocols, these notifications allow for additional communications between Express Scripts and the dispensing MTF to ensure all claims are accurate and safe. Claims with missing or invalid data are included on a daily or weekly MTF Claims Report, indicating that a review and or correction is required by the MTF to ensure that the beneficiary’s clinical profile is complete and accurate.
Prospective Drug Utilization Review (ProDUR)
Prospective Drug Utilization Review (ProDUR) evaluates each new prescription against the patient’s current drug regimen and returns appropriate clinical warnings or administrative alerts. As part of the adjudication process, Express Scripts performs a ProDUR on each transaction submitted by comparing transactions previously submitted from other points of service: MTF, TRICARE Pharmacy Home Delivery and retail network pharmacies.
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At an MTF pharmacy, a ProDUR will not result in a rejection of the claim, but instead will result in a ProDUR alert on the MTF system. These warnings are reviewed and reconciled at the point of service when a prescription is filled, as the MTF will respond to the alert by either cancelling the prescription or entering an override code. An appropriate override code will allow the transaction to continue through the adjudication process.
CHCS hosts will also provide ProDURs for all medications that have been dispensed from the MTF host; however, these warnings will not utilize claims from the other two points of service (i.e., retail and mail). In contrast, Express Scripts ProDURs provide review across all three points of service when examining a patient profile. The report associated with Express Scripts ProDUR warnings is discussed below in MTF Claims Corrections and Other Reports.
Claims Corrections and Other Reports
In order to ensure high quality and efficient claims adjudication, Express Scripts will provide each MTF several reports. Your claims team point of contact can review these reports with you to troubleshoot potential issues, and assist in designing plans to reduce frequent adjudication problems. A summary of each report along with any required follow-up action is provided below:
Report Name (#)
Recipient Description Action
Daily Validity Rejects Report (D010)
Submitting MTF Pharmacy POC
List of claims requiring correction sent to the pharmacy contact
MTF pharmacy has 3 business days to correct these claims. Examples include:
NDC missing or invalid
Compound did not come through correctly
Date dispensed is earlier than date written
Day supply is missing
Metric quantity is incorrect
Weekly High Cost Claims Report (W020)
Submitting MTF Pharmacy POC
List of all claims that exceed a $2,000 pricing threshold
MTF pharmacy has 7 business days to correct these claims. Examples include:
NDC is incorrect
Metric quantity is incorrect
Brand listed but generic dispensed
Day supply is incorrect
MTF CLAIMS REPORTS –
based on CHCS claims
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Weekly Data Integrity Report (W010)
Submitting MTF Pharmacy POC
List of claims that generated the following ProDUR warnings: High Dose Alerts and Invalid Provider
Express Scripts cannot make claim corrections on these items. Any corrections required will need to occur at the MTF.
Anytime a correction is required by the MTF, for any type of claim issue, the Express Scripts claims team can partner with the MTF to help troubleshoot these corrections. If changes to the Host MTF drug file (ADN) are required, MTFs are responsible for making the changes. MTFs are also responsible for correcting claims for initial fills and working with their claims team point of contact to correct refill claims.
For patient safety reasons, unless a claim is specifically reversed by the MTF pharmacy, the claim must be posted to the patient’s profile. In all situations, it is important these issues are worked timely to ensure the beneficiary’s clinical profile is complete and accurate.
For more information, contact [email protected]
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6. Resources available:
WEBSITES:
www.express-scripts/TRICARE
www.express-scripts.com/mobileapp
www.tricare.mil
@MilitaryRx on Facebook and Twitter
EMAIL CONTACTS:
General Inquiries: [email protected]
DPP: [email protected]
PMP: [email protected]
BENEFICIARY EDUCATION MATERIALS:
TRICARE pharmacy benefit brochures and posters
DPP brochures
To order, email quantity needed and mailing information to [email protected]
PHARMACY AND PROVIDER OFFICE RESOURCES:
To receive occasional relevant information, email your contact information to [email protected]
Quarterly newsletters are emailed.
DPP Brochures specific to pharmacies and provider offices.
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7. Glossary of Programs and Terms
Program / Term Definition
B2B Gateway Business to Business gateway allows two systems to communicate real time.
Catastrophic Cap The maximum amount a beneficiary can pay each fiscal year.
Claims Adjudication Claims adjudication is the process by which a prescription goes through ESI’s system resulting in the distribution of the correct drug, as well as any associated warning messages from the correct channel.
Client Website
The Client Website houses a suite of applications that offer ESI clients the opportunity to view standard reports, create and view customizable reports, submit queries to the Electronic Service Delivery (eSD) clinical management system. Access to the Client Website is approved by DHA.
Co-pays A fixed payment for a type of pharmaceutical owed by the beneficiary.
Daily Validity Rejects Report List of rejected claims (broken out by MTF) sent to the pharmacy contact.
Deployment Prescription Program (DPP)
The TMOP prescription program used by service members who are deployed overseas.
Express Scripts ESI’s enhanced mobile application that allows beneficiaries to manage pharmacy benefits from their smartphone or tablet - available through iPhone App Store or Google Play.
Federal Pharmacy Services Division (FPSD)
The department within ESI responsible for managing the TPharm contract and the provision of pharmaceuticals to TRICARE beneficiaries, within which an entire team of skilled individuals is dedicated to supporting the MTFs under the leadership of the MTF Program Manager.
Formulary Search Tool Website that allows beneficiaries to search whether a prescription is covered under the TRICARE benefit.
Military Health System’s Composite HealthCare System (CHCS)
Multi-function medical informatics system that includes a pharmacy module. This interface operates as a practice management system in the MTF pharmacies.
MTF Help Desk A dedicated number of all MTF inquiries (1-855-315-1921) primarily for general needs 24 hours a day 7 days a week.
MTF Retail Recapture The strategic process of attempting to move MTF beneficiary scripts from retail pharmacies to their closest MTF.
MTF to TMOP prescription transfer process
A capability of the CHCS which allows eligible MTF beneficiary prescriptions to be electronically transferred to the TMOP - MTFs must request authorization from DHA to participate in the program.
Other Health Insurance (OHI) Prescription benefits a beneficiary may have in addition to TRICARE.
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Patient Care Advocates (PCA) ESI staff trained to answer general MTF inquiries through the MTF Help Desk.
Pharmacy Benefit Manager (PBM)
Information‐based, clinically oriented service organization that manages prescription benefits for other companies. PBMs help many types of organizations cost-effectively provide prescription drug benefits for their participants.
Pharmacy Data Transaction Service (PDTS)
The PDTS is the system of record for prescription medications dispensed to TRICARE beneficiaries. This system consists of two major components: a Real-Time Transaction Adjudication process and a comprehensive Data Warehouse of all prescriptions dispensed to all beneficiaries. The PDTS Data Warehouse provides historical data to analyze information for decision support for enhanced pharmacy programs and development of future policies and procedures.
Pre-Deployment Site
Under DPP, the pre-deployment site should also provide the service member with a MOP reminder card and contact information. The Pre-Deployment Site also submits the DPP Rx form on behalf of the Service Member to Express Scripts.
Prescription Restriction Program
Prescription and utilization monitoring program to identify and prevent potential abuse by screening claims.
Prior Authorization (PA) The authorization that is required prior to medications being dispensed under TRICARE coverage.
ProDUR Alert Custom message that appears at the MTF during claim adjudication informing the dispensing MTF of a potential clinical or administrative issue - can be overridden at the MTF by entering an applicable override code.
Prospective Drug Utilization Review (ProDUR)
A step of the claims adjudication process that evaluates each new prescription against the patient’s current drug regimen and returns appropriate clinical warnings or administrative alerts.
Specialty Medication Care Management Program
If a beneficiary or their provider orders specialty medications through the TMOP, the beneficiary is automatically enrolled in the Specialty Medication Care Management program. This program offers beneficiaries continuous health evaluation and monitoring, along with the following: Professional and confidential consultation with experts who understand their condition, Refill reminder calls each month, 24/7 access to a pharmacist plus a nurse help line, Guidance on how to manage their medication therapy and take specialty medications correctly, Personal care through prescription benefit specialists, and Access to educational materials. These resources can help beneficiaries enrolled in the program take their specialty medication correctly, find local resources or answer health related questions, and is offered at no cost to beneficiaries.
Specialty Medications Specialty medications are usually high cost injectable or oral medications that treat serious, chronic conditions.
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Theater Medical Data Store (TMDS)
Automated Information System (AIS) is a services-oriented aggregation and distribution point for Theater Medical Data for Theater Medical Information Program (TMIP) family of systems. The purpose of the TMDS interface is to share outpatient prescription and pharmacy medical data stored in TMDS database with the Contractor’s system on a weekly basis.
TRICARE Beneficiary Website ESI maintained website (express-scripts.com/TRICARE) for TRICARE beneficiaries that houses helpful resources.
TRICARE Mail Order Pharmacy (TMOP)
Another name for the TRICARE Pharmacy Home Delivery program. Also referred to as Home Delivery.
TRICARE Pharmacy Home Delivery Program
Program whereby beneficiaries have their eligible prescriptions mailed to their residence. Certain restrictions apply to the medications a beneficiary can receive through the TMOP.
TRICARE’s Specialty Medication Care Management Program
Program offers various resources to facilitate the correct and adherent taking of specialty medications ordered through the TMOP.
US Family Health Plan (USFHP) TRICARE benefits offered to active duty family members, activated National Guard and Reserve family members, and retirees and their family members.
Warrior Transition Units Limited time specific utilization and prescription monitoring program for military personnel.
Weekly Data Integrity Report List of paid MTF claims that generated the following ProDUR warnings: High Dose Alerts and Invalid Provider.
Weekly High Cost Claims Report
List of all paid MTF claims exceeding the $2,000 pricing threshold.
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8. Comparison of DUR Messaging
DUR Warning Meaning Message Seen with ESI
Adjudication
High Dose Daily dose exceeds the quantity recommended
for most users
MX DOSE/ DAY // MAX DAILY DOSE // FDA
MAX DOSE / DAY: <<Description of
Maximum>>
Drug Disease Actual Drug conflicts with a disease on the patient’s
profile <<Name of Disease or Condition>>
Drug Disease Inferred Drug conflicts with a disease that is inferred
from the patient’s medication profile <<Name of Disease or Condition>>
Severe Drug Drug Drug conflicts with another medication active on
the patient’s profile (severe)
<<Name of Other Drug / Description of
Risk>>
Drug Drug Drug conflicts with another medication active on
the patient’s profile <<Name of Other Drug >>*
Additive Toxicity Drug with acetaminophen for accumulative
doses across drugs exceeding 4 grams/day
ADDITIVE TOXICITY: <<Name of Other
Drug>>
Minimum Use Below the minimum number of units normally
dispensed per day MIN DAILY QTY IS <<X.X>> PER DAY
Minimum Dose Below the minimum dose normally dispensed
per day MIN DAILY DOSE <<XX.X>>
Refill Too Soon Drug re-fill attempted while significant
medication is still active in the patient’s profile
NXT RFL:<<MMDDYY>> DAYS TO
RFL:<<XXX>>
Therapy Duplication Drug duplicates therapy of another drug active
in the patient’s profile <<Name of Other Drug>>*
Patient Age Drug may be inappropriate for the patient’s age <<Warning>>
Drug Gender Drug may be inappropriate for the patient’s
gender
CHECK DRUG; USUALLY FOR
<<MEN/WOMEN>>
Therapy Review
Medication-specific warning - quality assurance
based on medication dosage and clinical
appropriateness
<<Warning>>
Phonic Similarity Drug may be confused with other drugs SOUNDS/LOOKS LIKE <<Other Drug>>
Drug Pregnancy Drug may be inappropriate for pregnancy EVALUATE USE / CONTRAINDICATED /
AVOID IN PREGNANCY
Drug Allergy Drug may conflict with allergy on the patient’s
profile <<Name of Reported Allergen>>
Opiate Naïve Alert based on absence of long-acting opiates in
history
CONFIRM OPIOID TOLERANCE, NO
DOCUMENTED STRONG OPIATE USE WITHIN
60 DAYS
Absolute max days supply Days’ supply exceeds maximum days of 200 or
400
EXCEEDS MAX DAYS SUPPLY OF <<200 or
400>>