PBM 2.0.1 Drug Utilization Management, Pre-Appeal (DrUM 1-11, 14-18)
The following pages provide a basic summary, management tips, and accreditation advice for URAC's Drug Utilization Management, Pre-Appeal, standards in its Pharmacy Benefit Management Accreditation Program, v. 2.0.
- Pharmacy Benefit Management, Version 2.0 DrUM 1 - Drug Utilization Management Program Components
- Pharmacy Benefit Management, Version 2.0 DrUM 2 - Coverage Decisions Based on Clinical Information
- Pharmacy Benefit Management, Version 2.0 DrUM 3 - Review Criteria Requirements
- Pharmacy Benefit Management, Version 2.0 DrUM 4 - Prospective, Concurrent and Retrospective Drug Utilization Management
- Pharmacy Benefit Management, Version 2.0 DrUM 5 - Consumer Safety Process Requirements
- Pharmacy Benefit Management, Version 2.0 DrUM 6 - General Transition Process Requirements
- Pharmacy Benefit Management, Version 2.0 DrUM 7 - Review Service Disclosures The organization requires staff that provides drug
- Pharmacy Benefit Management, Version 2.0 DrUM 8- Prospective Reviewer Qualifications
- Pharmacy Benefit Management, Version 2.0 DrUM 9 - Rendering of Non-Certifications
- Pharmacy Benefit Management, Version 2.0 DrUM 10 - Automated Review
- Pharmacy Benefit Management, Version 2.0 DrUM 11 - Oversight of Automated Review Non-Certifications
- Pharmacy Benefit Management, Version 2.0 DrUM 14 - Written Notice of Non-Certification Decisions & Rationale
- Pharmacy Benefit Management, Version 2.0 DrUM 15 - Reversal of Certification Determinations
- Pharmacy Benefit Management, Version 2.0 DrUM 16 - Scope of Review Information
- Pharmacy Benefit Management, Version 2.0 DrUM 17 - Prospective, Concurrent, and Retrospective Review Determination
- Pharmacy Benefit Management, Version 2.0 DrUM 18 - Lack of information Policy and Procedure
- End of PBM 2.0.1 Drug Utilization Management, Pre-Appeal
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PBM 2.0.1 Drug Utilization Management, Pre-Appeal (DrUM 1-11, 14-18)
- Pharmacy Benefit Management, Version 2.0 DrUM 1 - Drug Utilization Management Program Components
- Pharmacy Benefit Management, Version 2.0 DrUM 2 - Coverage Decisions Based on Clinical Information
- Pharmacy Benefit Management, Version 2.0 DrUM 3 - Review Criteria Requirements
- Pharmacy Benefit Management, Version 2.0 DrUM 4 - Prospective, Concurrent and Retrospective Drug Utilization Management
- Pharmacy Benefit Management, Version 2.0 DrUM 5 - Consumer Safety Process Requirements
- Pharmacy Benefit Management, Version 2.0 DrUM 6 - General Transition Process Requirements
- Pharmacy Benefit Management, Version 2.0 DrUM 7 - Review Service Disclosures The organization requires staff that provides drug
- Pharmacy Benefit Management, Version 2.0 DrUM 8- Prospective Reviewer Qualifications
- Pharmacy Benefit Management, Version 2.0 DrUM 9 - Rendering of Non-Certifications
- Pharmacy Benefit Management, Version 2.0 DrUM 10 - Automated Review
- Pharmacy Benefit Management, Version 2.0 DrUM 11 - Oversight of Automated Review Non-Certifications
- Pharmacy Benefit Management, Version 2.0 DrUM 14 - Written Notice of Non-Certification Decisions & Rationale
- Pharmacy Benefit Management, Version 2.0 DrUM 15 - Reversal of Certification Determinations
- Pharmacy Benefit Management, Version 2.0 DrUM 16 - Scope of Review Information
- Pharmacy Benefit Management, Version 2.0 DrUM 17 - Prospective, Concurrent, and Retrospective Review Determination
- Pharmacy Benefit Management, Version 2.0 DrUM 18 - Lack of information Policy and Procedure
- End of PBM 2.0.1 Drug Utilization Management, Pre-Appeal
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