UnitedHealthcare Community Plan: New prescription safety edits

To help increase patient safety and prevent abuse and fraudulent activity, UnitedHealthcare Community Plan implemented new Concurrent Drug Utilization Review (cDUR) safety edits for pharmacy systems in October 2022.

These safety edits alert health care professionals to review the members’ current medications for therapeutic duplication, which may help prevent members from taking more than 1 drug in the same drug class.

We added the following drug classes and cDUR edits for our Community Plan:

How it works

1. At the point of sale, the pharmacist will be alerted of a therapeutic duplication
2. The pharmacist will then look at the member’s profile and contact the prescriber or member to determine if the member should receive both prescriptions.
3. If the pharmacist determines the prescription should be processed, they can override the alert by entering the appropriate reason codes
4. Pharmacies will receive a fax explaining these safety edits and what action needs to be taken to override them
5. If the pharmacist overrides the alert excessively, the prescription will require a prior authorization.
6. Prescribers can submit prior authorization requests by faxing Optum Rx® at 866-940-7328. To receive more information, prescribers can call Optum Rx at 800-310-6826.

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