In PBM claim adjudication, which step triggers safety alerts such as drug interactions?

In PBM claim adjudication, which step triggers safety alerts such as drug interactions?

• A. DUR electronically determined
• B. Verify belongs to member
• C. Price determined
• D. Verify it's on formulary

Answer: (A)

Drug Utilization Review, performed electronically during the claim adjudication workflow, is the step that flags potential safety issues such as drug interactions. As the PBM processes the prescription, the DUR engine cross-checks the proposed drug against the patient’s current medications, allergies, dosage guidelines, and contraindications. When a potential interaction is detected, it generates safety alerts to warn the pharmacist or clinician and prompt review before dispensing or payment approval. Other adjudication steps—verifying member eligibility, determining price, and checking formulary status—address eligibility, cost, and coverage and do not trigger these safety interaction alerts.

Drug Utilization Review, performed electronically during the claim adjudication workflow, is the step that flags potential safety issues such as drug interactions. As the PBM processes the prescription, the DUR engine cross-checks the proposed drug against the patient’s current medications, allergies, dosage guidelines, and contraindications. When a potential interaction is detected, it generates safety alerts to warn the pharmacist or clinician and prompt review before dispensing or payment approval. Other adjudication steps—verifying member eligibility, determining price, and checking formulary status—address eligibility, cost, and coverage and do not trigger these safety interaction alerts.