Last Updated: Monday, September 27, 2021
Pharmaceutical Management (Clinical Management Programs) is designed to safeguard patients from potentially harmful drug interactions and side effects, optimize clinically appropriate therapy, promote appropriate prescription drug utilization and promote compliance with recommended drug quantity, dosage and intended use of product. These programs bring together every individual or entity involved in the management and delivery of pharmaceutical care: plan sponsor, physicians, members, and pharmacists. The programs are administered across all lines of business and are seamless across both retail and home delivery prescription drug benefit programs. These programs achieve their goals by:
Pharmaceutical management programs include the following:
Concurrent/Prospective Drug Utilization Review (DUR)
Retrospective Drug Utilization Review (DUR)
To view policies, view Pharmacy Policy Search on the left menu or in the Quicklinks at the top of the page.
Changes and updates to all clinical management programs are distributed bi-monthly through the Formulary Update, which is distributed to all network providers.
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Additional information on Prescription Drug Programs can be found in the Highmark Provider Manual - Chapter 4, Unit 6.