Leverage Specialty Pharmacy Services in Complex Workers’ Comp Claims

Leverage Specialty Pharmacy Services in Complex Workers’ Comp Claims The increasing use of prescription medications places unique challenges on workers’ compensation programs.  Part of the problem is the complex nature of these issues.  This includes the use of “specialty pharmacy” to address the needs of complex matters.



What is Specialty Pharmacy?


The pharmaceutical business is always changing.  One of those changes is the rise in “specialty pharmacy,” which fills specialized prescription drugs, or those that are needed for small groups of patients with complex, chronic conditions. These prescriptions require additional care in their dispensing, handling, and delivery including patient education and training on side effects and self-administration of drugs beyond what is available at a typical retail pharmacy.


Specialty Pharmacy staff including nurses and pharmacists will be trained in complex conditions and treatments to offer patients additional education and resources.



Specialty Pharmacy and Its Impact on Work Comp


According to the latest Express Script’s Workers’ Compensation Drug Trend Report, specialty drugs account for 5.9% of total pharmacy costs, yet account for less than 1% of drugs used by injured workers’.


Specialty pharmacies focus on prescription medications that are not commonly used and dispensed.  These medications usually affect high-risk occupations that have unique challenges.


Some examples of conditions where specialty pharmacy come into play include:


  • Hepatitis C infections;
  • HIV/AID treatment;
  • Various cancers; and
  • High blood cholesterol­­­.



Common specialty prescription medications used include:


  • Harvoni® (ledipasvir/sofosbuvir): Antivirals (hepatitis C)
  • Enoxaparin sodium: Anticoagulants
  • Enbrel® (etanercept): Anti-inflammatories
  • Truvada® (emtricitabine/tenofovir): Antivirals (HIV)
  • Gleevec® (imatinib): Oncology drugs
  • Isentress® (raltegravir): Antivirals (HIV)
  • Xolair® (omalizumab): Asthma and allergy drugs



Implementing Specialty Pharmacy to Reduce Program Costs


Using a specialty pharmacy as part of your workers’ compensation program is essential for any workers’ compensation program administrator who seeks a competitive advantage in complex cases.  Use of this program can drive down costs and maintain a high standard of care for injured workers with the most complex and chronic conditions.


In the area of specialty pharmacy, the increasing cost associated with lifesaving prescription medications is primarily driven by two factors: an increase in the average cost per prescription, and increased utilization costs associated with specialty pharmacy medications.


Implementation of a specialty pharmacy program should be part of working pharmacy benefits manager relationship with expertise in this area.  Run a pilot program for 60-90 days to evaluate and compare your results to industry benchmarks.





To be successful with complex and chronic conditions, workers’ compensation program administrators and members of the claim management team should be aware of and utilize specialty pharmacies.  This will allow them to properly manage and reduce costs for specialized prescriptions that can cure and relieve the effects of uncommon workers’ compensation injuries.




Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.


Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/


©2018 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

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