High-risk medication utilization reviews

Our reviews target two main areas.

Drugs to avoid in the elderly

Humana has implemented Pharmacy Quality Alliance, Centers for Medicare & Medicaid Services, American Geriatric Society and National Committee for Quality Assurance measures for high-risk medications (HRMs) in the elderly. In addition, “Drugs to be Avoided in the Elderly” is measure 238 of the Centers for Medicare & Medicaid Services 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

We encourage prescribers to review these specific medications to avoid and formulary alternatives.

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

To view coverage for formulary alternatives, see Humana's Drug List.