Exception Management

Exception management handles members who exhibit metabolic instability, non-adherence, or other contraindications during tapering protocols. This is a critical safety layer.

What triggers an exception

Exceptions are triggered by metabolic decompensation (weight regain, glucose instability), medication non-adherence, member-reported adverse effects, or prescriber intervention requests. Exception criteria are predefined in clinical protocols.

Exception pathways

When an exception is triggered, members are automatically moved to exception pathways which may include dose stabilization, protocol suspension, or tapering termination. Exception pathways prioritize member safety over cost reduction objectives.

Clinical oversight

All exceptions are reviewed by clinical personnel. High-severity exceptions trigger immediate escalation to medical oversight teams. Exception resolution is documented for audit and outcome analysis.

Employer notification

Employers are notified of exception trends (aggregate only) through quarterly reporting. High-rate exception cohorts may indicate inappropriate population targeting and trigger protocol recalibration discussions.

Exception rate thresholds

Exception rates are monitored against predefined thresholds. If exception rates exceed thresholds, tapering protocols are suspended pending clinical review. Exception thresholds are established during pilot engagements and validated before scale.