Implementing a Clinically Driven Pharmacy Benefits Program

In speaking with Danielle Lisenbey, Chief Operating Officer of Broadspire's Medical Management Services, I learned how important a good pharmacy benefit management program is and what to look for when shopping for a PBM (pharmacy benefit management) program. Lisenby also updated on how the cost of pharmcacy costs has increased.
The 2010 Annual Drug Trends Report for Workers Compensation indicates pharmacy costs in 2009, rose 6.5% with workers taking an average of 11.1 prescriptions per injury.

Employers may want to implement a clinically driven model to reduce pharmacy costs – one targeting these areas: (WCxKit)

1. Delivering appropriate medications to your injured workers.

2. Managing escalating prescription costs.

3. Reducing opioid misuse or abuse.

4. Helping return employees to productivity.

A pharmacy benefit management program uses evidence-based medicine designed to help employers gain more control over costs associated with workers compensation claims. These key points need to be in your program:

1. Utilization management experts assess medications for appropriate use in work related injuries.

2. Examine pharmaceutical data to discover possible misuse or abuse.

3. A clinical review team of nurses and doctors help control prescription costs by working to eliminate:

a. Inappropriate fills.

b. Duplicate prescriptions from multiple providers.

c. Prescription overuse beyond claim guidelines.

d. Multiple prescriptions that counteract or adversely affect one another.

Think in broad terms by giving employees access to multiple pharmacies in a reputable pharmacy management network and mail order service. Look for providers that link to pharmacies in real-time and immediately approve medications at the counter to reduce out-of-pocket expenses for your injured employees. The technology is efficient, with rejected scripts saving employers over 48% of costs in 2009. Look for a provider wtih 24/7 service and toll free access to a pharmacy customer care line. Patient care advocates, bill processors and registered pharmacists should be available to answer any questions that arise. The center also must track orders, prescriptions and other pharmacy program information for every claim. (WCxKit)

A pharmacy program integrates fully with claim, medical bill review and utilization management departments. This close connection helps promote early enrollment for injured workers and allows employers to take greater advantage of the cost saving potentials.

Contributor: Broadspire provided content about their workers compensation medical management services.
For more information, contact Broadspire at 1-866-625-1662 or emailing [email protected]; www.choosebroadspire.

WC IQ TEST: http://www.workerscompkit.com/intro/

WORK COMP CALCULATOR: http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR: http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
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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.