The medical costs resulting from workers’ compensation claims have risen for decades and now exceed indemnity costs. Prescriptions represent a significant portion of those medical costs and with maintenance drugs, many claims carry lifetime cost potential at a very high price. Pharmacy Benefit Management companies (PBMs) go a long way toward controlling costs by establishing formularies specifying which drugs will be authorized and requiring generics when possible. Mail order services offered by the PBM can also save money.
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Another area for control of potentially addictive medications considered “controlled substances” that are part of a particular class of drugs rests in legislation enacted at the state level by way of a Prescription Monitoring Program (PMP). Prescribing physicians and dispensing pharmacists subscribe and participate in these programs designed to prevent the abuse or misuse of certain medications.
Currently, 38 states have PMPs in place or in progress. The 32 states with operational programs include AL, AZ, CA, CO, CT, HI, ID, IL, IN, KY, LA, ME, MA, MI, MS, NV, NM, NY, NC, ND, OH, OK, PN, RI, SC, TN, TX, UT, VA, WA, WV and WY. The 6 pending full operation are AK, IA, KS, MN, NJ and VT. See:
The way the program works is the participating prescribing physician and dispensing pharmacist are required to report weekly to the PMP all applicable drugs within certain classes prescribed or dispensed that week. The prescribing physician and dispensing pharmacist have access to the patients’ drug history of the applicable “controlled substances” so that they’re able to detect “Dr. Shopping” for the “controlled substances” from multiple sources.
The pharmacist or physician uses this information for early identification of patients at risk for addiction and to initiate appropriate medical intervention. This is not a mandatory program in all states for prescribing physicians and dispensing pharmacists. There are states planning to implement interstate agreements to share prescription information with neighboring states to identify doctor shopping patients who cross state lines. (workersxzcompxzkit)
How can this help your workers’ compensation costs? Encourage your occupational medicine providers and specialists utilized in treating your injured employees to participate in this program. If you have injured workers with a substance abuse problem, the physician should be able to detect the problem and take appropriate steps in getting your employee the help he or she needs to remain a successful and productive member of your workforce.
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.
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