- Do you know the main component missed by risk managers in Pharmacy Benefit Management (PBM)?
- Do you know the six reasons to use pharmacy benefit management?
- Does your Pharmacy Benefit Management program have both prospective and retrospective elements?
- Are you implementing the eight PROACTIVE Drug Management Techniques?
- Does your company consider the THREE PROBLEMS with narcotics for pain control and take preventative steps?
- Can your company properly review the drug management program of your Third Party Administrator or insurance carrier?
- Can you identify the key selection criteria for a PBM?
- Do your supervisors know the “red flags” of drug abuse?
Drug costs are not only the fastest growing component of medical care but also one of the most neglected areas of workers’ compensation cost control. Proper utilization of pharmacy benefits management can result in substantial savings. There are steps employers can take directly to prevent misuse of medication, and they can also contract with a pharmacy benefits management vendor. Most TPAs and insurance companies are aligned with these pharmacy benefits management programs.
Employers can take these steps to avoid overuse and abuse of prescription medications by proactive management over the life of the workers’ compensation claim. Questioning medication overuse becomes more difficult after the employee is addicted.
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- When employee is on narcotics 60-plus days and making limited medical progress: Ask the nurse case manager or the adjuster to inquire from the doctor’s office what else, besides medications, can be done to fix the cause of the employee’s pain or other problem(s).
- When the gentle approach fails: Ask for a peer review during which the carrier or third-party administrator’s staff doctor telephones the treating physician to discuss the appropriateness of dosage and impact the medications are having on the injured employee. If addiction is suspected, recommendations are discussed on how to wean the employee from these drugs.
And More
When retaining a Pharmacy Benefits Management vendor, consider these components:
- Authorized drug formulary and generic availability.
- Evidenced-based drug guidelines.
- Access to physicians representing multiple specialties.
- And More
Key Service Points for Pharmacy Benefits Management
- Compliance with each jurisdiction’s workers’ compensation regulations.
- Technology to process real-time prescriptions.
- National pharmacy network.
- Comprehensive formulary specific to workers’ compensation.
- Provide correct pricing when drugs are dispensed from the doctor’s office.
- Mail order service for medications taken regularly. A must for non-ambulatory patients.
- And Many More
For more information about this chapter, see the Table of Contents
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