High-risk medication utilization reviews

Our reviews target two main areas.

Drugs to avoid in the elderly

The American Geriatrics Society updates the Beers Criteria list to give guidance for potentially inappropriate medications in the elderly. As a result of the Beers Criteria, the Pharmacy Quality Alliance has created the performance measure, “Use of High-Risk Medications (HRM) in the Elderly (HRM).” This performance measure has been adapted by the Centers for Medicare & Medicaid Services (CMS) to aid health plans in developing quality improvement initiatives for their members. Humana implements the quality measure “Use of High-Risk Medications in the Elderly” and strives to provide evidence-based messaging, not only for our members, but also for health care partners.

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.