CenCal CareConnect is sharing this clinical safety update to support care for older adults at increased risk for falls. Medications are a common contributing factor, especially with polypharmacy.
This notice does not change coverage, prior authorization, or step therapy criteria. It highlights existing formulary safeguards and the coverage determination and exception process that may be helpful in fall-risk scenarios.
Key Points
Older adults may be more sensitive to medications associated with sedation, dizziness, orthostasis, or cognitive effects. Fall risk is often associated with:
- CNS-active agents (sedatives, some antidepressants, antipsychotics)
- Opioids and other analgesics
- Skeletal muscle relaxants
- Anticholinergic medications (bladder, allergy, sleep agents)\
CareConnect Formulary
Some medications include utilization management flags that support safe use when clinically appropriate:
- ST (Step Therapy)
- NDS (Non-Extended Days Supply)
- QL (Quantity Limit)
- PA-HRM (High-Risk Medication)\
Clinical Considerations (as applicable)
- Consider overall medication burden and combinations that may increase sedation or dizziness
- Consider dosing and monitoring in members with prior falls or frailty
- Use the coverage determination or exception process when a higher-risk medication is clinically necessary
Resources
- Formulary, PA, and Step Therapy: cencalhealth.org/careconnect
- Member Services and Provider Assistance: 1-877-814-1861 (TTY 711), 7 days/week, 8 a.m. to 8 p.m. PT
Thank you,
CenCal CareConnect Pharmacy Team