Quality Assurance Policies & Procedures

What are our prescription drug quality assurance measures and systems?

Alterwood Advantage has a comprehensive prescription drug quality assurance (QA) program that aims to reduce medication errors and adverse drug interactions; and improve medication use. This program is multi-faceted to ensure members receive access to high quality prescription drug coverage. The multi-faceted components include, but are not limited to, the following QA measures and systems:

  • Concurrent drug utilization review (DUR) systems, policies and procedures
  • Retrospective DUR systems, policies and procedures
  • Medication error identification and reduction systems (MEIR)
  • Pharmacy network of credentialed pharmacies that comply with the minimum standards for pharmacy practice established by the States
  • Promotion of voluntary e-prescribing, Medwatch reporting, and 
  • Medication Therapy Management

Alterwood Advantage’s concurrent DUR program ensures that every time a prescription is dispensed, the following reviews occur that network pharmacy point-of-sale (POS) system:

  • Screening for potential drug therapy problems due to therapeutic duplication
  • Age/gender-related contraindications
  • Over-utilization and under-utilization
  • Drug-drug interactions
  • Incorrect drug dosage or duration of drug therapy
  • Drug-allergy contraindications
  • Clinical abuse/misuse

Alterwood Advantage’s retrospective DUR program is designed to ensure ongoing periodic examination of prescription drug claims and other records, through computerized drug claims processing and information retrieval systems, in order to identify patterns of inappropriate or medically unnecessary care among Alterwood Advantage members or associated with specific drugs or groups of drugs. Potential fraud, waste, and abuse (FWA) situations are referred to the internal Special Investigative Unit (SIU).

Alterwood Advantage’s MEIR program is focused on preventing, identifying, and reducing medication errors. Medication errors are defined as:

‘‘[A]ny preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer. Such events may be related to professional practice; healthcare products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.’’ (See 68 FR 12501 (March 14, 2003)).

Alterwood Advantage has partnered with Elixir to establish its pharmacy network. Elixir, formerly EnvisionRxOptions, is a pharmacy benefits and services company with the scale and experience to provide our members real value. They are also committed to quality and ensure pharmacies credentialed into the pharmacy network meet the minimum standards for pharmacy practice established by the States.

Alterwood Advantage promotes e-prescribing through its provider network and included in the Provider Manual. We encourage all prescribers to adopt e-prescribing technology to avoid medication errors. This will also facilitate getting the right prescription processed by a network pharmacy. More information on e-prescribing can be found at www.cms.gov/Medicare/E-Health/Eprescribing.

Alterwood Advantage highly recommends providers and prescribers to report adverse events and product problems to MedWatch. In addition, adverse events related to vaccines should be reported to the Vaccine Adverse Event Reporting System (VAERS). More information on MedWatch and VAERS can be found at www.accessdata.fda.gov/scripts/medwatch and www.vaers.hhs.gov/index.html, respectively.

MedWatch Reporting

Healthcare professionals and consumers may report adverse events and product problems to MedWatch by calling 1800-FDA-1088, by submitting the FDA MedWatch 3500 form online at www.accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home

VAERS Reporting

Healthcare professionals and consumers may report vaccine adverse events and problems online at www.vaers.hhs.gov/reportevent.html.


If you have any questions regarding Alterwood Advantage’s prescription drug quality assurance program, please contact the Health and Quality department at 667-262-9412 or 866-675-3944 toll-free. TTY: 711. Calls to this number are free. We are available from 8:00 AM to 5:00 PM Monday through Friday except for major holidays.