Question

Which of these statements is NOT true about the drug utilization management (UM) rules?

Answer 1

The false statement about the drug utilization management rules is ; ( D ) If a medication has a UM rule , the member will not be able to get that medication

UM rules are meant to ensure the judicious use of a facility's resource such as drugs through the review of drug users and the cost reduction techniques proposed by health insurance plans.  

These rules are applied to high cost drugs for the treatment of special diseases such as cancer. the UM rules employ certain techniques to execute the UM rules which are ;

• Prior authorization
• Step therapy
• Quantity limits  and
• Generic substitution  

Hence we can conclude that the false statement about the drug utilization management rules is ; ( D ) If a medication has a UM rule , the member will not be able to get that medication.

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