Aligning With Payers for Cost Containment

Jan 31, 2014
Insurers and pharmacy benefit managers, such as Express Scripts, work together to rein in costs while providing quality care for injured workers.
  • Workers' Compensation Insurance

A recent article in Claims Management  titled "Prescribing Success," highlighted the value of insurers and pharmacy benefit managers (PBMs), such as Express Scripts, working together to rein in costs while providing quality care for their injured workers. We couldn’t agree more.

Today more than ever, workers’ compensation payers are confronted with effectively mitigating risks and managing challenging pharmacy issues. Express Scripts has a suite of cost containment tools available to help payers manage these challenges.

Generics in Workers’ Compensation

The article highlighted that:

The PBM should encourage the use of drugs that have a less expensive generic equivalent.

Even though they have no financial incentive to do so, our findings showed that when injured workers are sent a “social responsibility” letter explaining how their prescription drug choices could help control the rising cost of healthcare, they were 60% more likely to choose a generic equivalent. Express Scripts’ Injured Workers Generics Letter leverages behavioral science research to encourage injured workers to choose a lower-cost alternative.

Channel Optimization

The authors also suggested that:

The PBM should promote a convenient way to order maintenance medications and have them delivered to the home or office. The efficiency of this process along with the bulk purchasing power enables the PBM to offer prescriptions at a more economical price.

The channel through which injured workers receive their medication has great potential for cost savings for payers. The checks and balances provided by Express Scripts’ home delivery pharmacy also help ensure the safety of injured workers.

Other ways to control costs through channel management include greater oversight to address the costly practice of physician dispensing and streamlining administrative burden through paper bill conversion.

Utilization Management

The article also highlighted the importance of ensuring appropriate utilization to reduce potential risk and abuse:

The PBM will … provide concurrent (point of sale) or retrospective intervention solutions that target specific problems dealing with drug interactions, dosage issues, duplicate therapy, substance abuse or pharmacy/prescriber ‘shopping.'

Our Morphine Equivalent Dose Management program is a proactive approach to real-time management of narcotic utilization – the category with the highest per-user-per-year cost in workers’ compensation pharmacy claims. We also have other programs in place, including Concurrent and Retrospective Drug Utilization Review, as well as other outreach programs to prescribers to ensure the safety of injured workers.

We’re proud to support payers’ goals of better treatment outcomes for injured workers while efficiently managing costs.

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