Drug utilization review

High-risk medication utilization reviews

Our reviews target two main areas.

High-risk medications to avoid in the elderly

The American Geriatric Society updates the Beer’s Criteria list to give guidance for potentially inappropriate medications in the elderly. As a result of the Beer’s Criteria, the Pharmacy Quality Alliance creates the performance measure, High Risk Medication (HRM) in the Elderly. This performance measure is adapted by the Centers for Medicare & Medicaid Services (CMS) to aid health plans in developing quality improvement initiatives for its members. Humana implements the quality measure High Risk Medications in the Elderly and strives to provide evidence-based messaging, not only for our members, but for our health care partners as well.

In addition, “Drugs to be Avoided in the Elderly” is measure 238 of the CMS Physician Quality Reporting System.

Health care providers may receive a faxed clinical alert from Humana when a patient is receiving an HRM.

Sample HRM alert (194 Kb)(link opens in new window) 

We encourage prescribers to review these specific medications to avoid and formulary alternatives (74 Kb)(link opens in new window) 

Drug-to-disease interactions

Some drugs are contraindicated due to a disease or condition an elderly member has. Humana may fax the following alert to health care providers concerning drug-to-disease interactions in the elderly:

Sample drug-to-drug disease clinical alert (140 Kb)(link opens in new window) 

To view coverage for formulary alternatives, see Humana's drug lists.