CONFIDENTIAL AND PROPRIETARY
Program which reviews every prescription, every day. This program helps payors save money on expensive and preventable healthcare costs while improving members’ well- being.
Every day, MedMonitor’s software analyzes the merged prescription and available medical claims, from the prior 72 hours, to identify those patients who may be at risk for potential medication-related problems. Higher-risk patients, or those patients who have potentially severe conflicts identified, will have their profile reviewed by a Clinical Care Center pharmacist. If the pharmacist determines that the conflict is significant and has the potential to cause an adverse outcome, the pharmacist will contact the provider(s) involved in the patient’s care. Providers may include the member’s prescriber or dispensing pharmacy. Providers may be contacted via phone, fax, or letter.
The alert notification informs the provider of the situation by stating the medications involved and any possible outcomes that may be observed. Each alert includes the citation(s) to the relevant medical literature from which the specific conflict edit was created, as well as the patient’s prescription and medical profile (if available). A voluntary provider feedback form is included to allow the provider the opportunity to give information to update the patient’s healthcare history for future clinical evaluations and offer comments used for the continuous quality improvement of our program. It is important to note that all communications with providers are intended solely to supplement the information they may have about their patients; they do not replace a provider’s extensive medical knowledge or expertise.
Our program consists of the following clinical interventions:
These interventions identify patients who are receiving two or more medications that, when taken together, can cause unpredictable or undesirable effects.
These interventions identify patients who are receiving drugs that may worsen medical conditions (inferred through prescription claims).
Drug-Diagnosed Disease Interactions
These interventions identify patients who are receiving drugs that may worsen medical conditions (actual ICD-9 codes, CPT-4 codes).
These interventions identify patients who are not receiving certain drugs which are considered national standards of therapy for certain medical conditions. A subset of
Walgreens Health Initiatives – Pharmacy Manual