Cigna-HealthSpring currently utilizes a clinical program which is designed to review a member’s prescription history for possible drug related concerns. The goal is to improve the quality and cost effectiveness of dispensed medications by ensuring adjudicated prescriptions are clinically appropriate. The edits in place can be easily overridden by using the appropriate DUR/PPS Reason and Result codes found below. This edit assesses the total daily dose based on FDA approved maximum dosing information. The edit identifies single incoming claims of concern as well as overlapping claims with the member’s history based on specific ingredients. The edit will be triggered if the total daily dose exceeds the FDA-defined maximum daily dose.