Patient Pharmacy Safety Initiatives

The health and safety of our members is a priority for Gateway Health Plan. One of the ways we address patient safety is through point-of-sale (POS) edits at the pharmacy. These safety edits ensure that our members are utilizing their medications in a safe and effective manner. Below are two such edits currently in place. Please contact our pharmacy department at 1-800-528-6738 if you have any questions.

Acetaminophen Maximum Dosing Edit

• Acetaminophen (Tylenol ®) is an over-the-counter fever reducer and pain reliever.
• It is also combined with some prescription analgesics to form prescription pain relievers such as Vicodin ® or Percocet ®.
• The maximum recommended total daily dose of Acetaminophen is 4000mg or 4gm per day. Taking more than this amount is very dangerous and can result in liver damage.
• For this reason, Gateway Health Plan^®has instituted a hard edit to prevent medications containing acetaminophen to exceed a total daily dose of 4gms.
• If a medication containing acetaminophen is being filled for a quantity and dosage that would exceed this 4gm/day limit the prescription will reject at the point of sale at the pharmacy.
• The prescription will only go through if the acetaminophen dosage can be adjusted not to exceed the 4gm/day limit.

Maximum Allowed Daily Dose (MADD) Edits for Atypical Antipsychotics

• Atypical antipsychotics are a relatively new class of medications that are used in the treatment of schizophrenia.
• Atypical antipsychotics have less severe side effects than conventional antipsychotics that were traditionally used to treat this disease.
• The goal of treatment for schizophrenia is to use the least amount of medication possible to manage both the positive and negative symptoms effectively while limiting unwanted side effects.
• For this reason, Gateway has instituted a Maximum Allowed Daily Dose (MADD) edit for all atypical antipsychotics.
• The edits are based on the maximum recommended daily dose listed in the package insert of each product.
• If the dose exceeds the MADD edit, the prescription will reject at the point of sale at the pharmacy.
• Requests for doses above the maximum recommended daily dose should be faxed to Gateway at 412-255-4544 or 888-245-2049 for review. Please include rationale for medical necessity and prior treatment failures.

** Regimen should not exceed 4grams of acetaminophen per day

**Generic substitution is mandatory when generic equivalent exists.

8/30/04