Reducing Fraud and Abuse

One of the options under the HID Pro-DUR system is to put hard edits in place that provide early refill control for medication. This provides an important means of fraud and abuse control. If a patient attempts to obtain an early refill (a refill sought before 75% of the previous prescription should have been used), the hard edit prevents the pharmacist from dispensing the refill. Under extenuating circumstances, as defined by the client, the pharmacist can call the Health Information Designs help desk/call center and obtain an override number that allows the refill claim to be accepted.

Some of these extenuating circumstances might include:

· A doctor-ordered change in dosing
· Medication stolen as documented in a police report
· Medication destroyed by fire as documented by fire marshal report
· Patient going out of town for more time than the 25% already allowed

To reduce the risk of possible abuse of controlled substances some clients allow no override for these substances.

Implementing HID’s early refill control has been shown to decrease the number of early refills to a third of the previous volume.
To discuss how HID’s Prospective DUR program can be of value to you please contact Sales at sales@hidinc.com.