Which statement is NOT true about drug utilization management rules?

The statement that a medication with a utilization management (UM) rule cannot be obtained at all by a member is misleading. Utilization management rules are designed to ensure that medications are prescribed appropriately and are used safely, but they do not outright deny access to all medications that fall under these rules. Instead, these rules may impose certain requirements, such as prior authorization, step therapy, or quantity limits, which must be met before the medication is dispensed.

The intent of UM rules is to help promote proper use of medications and help control costs while maintaining a high quality of care. Members may still receive the medication by fulfilling the criteria outlined in the UM process. Therefore, while it is true that a UM rule may complicate access to medication, stating that a member will not be able to get that medication is inaccurate as there can be exceptions or pathways to gain approval.