Part D Quality Improvement

PART D QUALITY IMPROVEMENT

PART D QUALITY IMPROVEMENT


MeridianComplete has established a Quality Assurance program that is designed to ensure our members receive high quality, medically appropriate and cost effective health care. The program monitors and evaluates the quality and appropriateness of services provided. In addition, the program provides the framework to pursue opportunities for improvement and problem resolution. 

 

MeridianComplete has also developed Drug Utilization Review (DUR) systems to identify drug-drug interactions, unusual dosage of a particular drug, concerns with the age and/or gender of the consumer and various other factors.

 

The MeridianComplete DUR system evaluates the appropriateness of the prescription at the point-of-sale by utilizing the following safety edits:

  • Drug-Drug: This edit will alert the pharmacy if there is another medication that interacts with the medication being filled.
  • Therapeutic Duplication: This edit will alert the pharmacy if there is another medication that is considered a therapeutic duplication.
  • Dose Optimization: This edit will alert the pharmacy if the dose requested is outside of the normal dosing and duration/range of therapy guidelines.
  • Drug-Age: This edit will alert the pharmacy if the drug should not be used for consumers in a specific age range, based on FDA regulatory guidelines.
  • Drug-Gender: This edit will alert the pharmacy if the drug should not be used for consumers of a specific gender.
  • Drug-Pregnancy: This edit will alert the pharmacy if the drug should not be used for female consumers of reproductive age.

MEDICARE DISCLAIMER

MeridianComplete is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees.

 

You can get this document in Spanish, or speak with someone about this information in other languages for free. Call

1-855-580-1689 (TTY users should call 711)

,

Monday - Sunday, 8 a.m. to 8 p.m.

  The call is free.

 

Usted puede obtener gratuitamente este documento en español o hablar con alguien sobre esta información en otros idiomas. Llame al

1-855-580-1689

(los usuarios de TTY deben llamar al 711), lunes a domingo, de 8 a.m. a 8 p.m. La llamada es gratuita.

 

Limitations, copays, and restrictions may apply. For more information, call MeridianComplete Member Services or read the MeridianComplete Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year

The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.

 

Copays for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for more details.

 

For certain kinds of drugs, you can use the plan’s network mail-order services. We also have an optional automatic mail-order delivery program under which we will automatically fill all new prescriptions your health care provider sends to us, as well as refills for prescriptions that have already been filled but are running out. Usually a mail-order pharmacy order will get to you in no more than 5 days. If you experience any problems receiving your mail order prescription, call Member Services at

1-855-580-1689 (TTY users should call 711)

.

Page Last Modified: 11/20/2017 2:43:27 PM