Clinical Services

PDMI's primary goal in providing clinical services for our clients' pharmacy benefit plans is to ensure the best outcomes for your members while providing them with the most cost-effective therapy. We work closely with our clients in providing a comprehensive suite of clinical options that will best fit their business objectives.

Concurrent Drug Utilization Review

PDMI utilizes on-line, real-time drug utilization review (DUR) procedures to prevent drug duplication and to identify drug interactions. We use NCPDP's DUR modules along with Medi-Span DUR criteria to check for drug interactions. We also have proprietary algorithms established to detect duplicate therapy.

Retrospective Drug Utilization Review

Retrospective programs intended to identify those cases where patient health and safety may be in jeopardy.

Polypharmacy Monitoring and Alerts

We have developed proprietary logic and reporting to identify those patients at risk of taking an abundance of drug therapy, with an emphasis on those taking duplicative therapy as well as therapy used to treat the side-effects of other drugs on their profile.

Fraud, Misuse and Abuse

Comprehensive audit programs designed to minimize the risk to the plan.

Compliance and Adherence Programs

Programs targeted at ensuring appropriate utilization on drug classes where patient compliance is a must to ensure the best possible outcomes.

Drug Pipeline Monitoring

Close watch of those brand and generic drugs that are in the pipeline to ensure that the impact of every new drug is clearly understood when it hits the market.

Coverage Authorization

Prior authorization, step therapy, quantity limitations and dose duration rules are constantly being created and re-evaluated to ensure clinical appropriateness and effectiveness.