Reining in the Cost of Physician Dispensing

Feb 27, 2014
Express Scripts’ Physician-Dispensed Medication Solution provides payers visibility into the true cost of medication.
  • Workers' Compensation Insurance

Ensuring safe treatment for injured workers, while controlling costs for payers, is our fundamental goal.

Announced today, the Express Scripts Physician-Dispensed Medication Solution provides payers visibility into the true cost of medication and helps reduce costs resulting from physician dispensing of medications.

The Challenge of Physician-Dispensed Medications

When a physician dispenses medication to an injured worker, the drugs are repackaged and assigned a new National Drug Code (NDC). This allows for a new average wholesale price, which is typically much higher than that of the original manufacturer. According to a study from the Workers Compensation Research Institute, these drugs can be priced 60% to 300% higher than an identical drug dispensed through a pharmacy.

A Comprehensive Solution for Physician Dispensing

The Express Scripts Physician-Dispensed Medication Solution uses comprehensive pharmacy data to review medications billed to the payer. The prescriptions are processed against the payer’s formulary, the plan design and all prescription history.

The enhanced adjudication system also helps payers stay compliant with workers’ compensation laws by processing bills against specific state guidelines. This helps reduce costs and drive out waste. Some states require physicians to bill payers using the original NDC price, while other states prohibit the practice all together. The Express Scripts solution is completely customizable based on the state jurisdiction.

After these reviews, Express Scripts re-prices and issues the appropriate payment.

Safety Utilization for Injured Workers

In addition to reducing waste from physician dispensing, the program also helps ensure injured worker safety.

When injured workers receive medication through a doctor’s office – especially one that is not the primary treating physician – they are at risk for potential drug interactions or duplication of therapy. Since Express Scripts has full visibility of every medication dispensed to an injured worker, the safety checks we provide lead to better clinical outcomes.    

Leveraging Behavioral Science Expertise

At Express Scripts, our solutions are based off extensive behavioral science research. We leverage this understanding to encourage injured workers to make better decisions about their treatment and help control costs.

Express Scripts sends educational letters to injured workers who have received medication from a doctor’s office, highlighting the cost impact of their decision on their employers or workers’ compensation payers and encouraging them to fill future prescriptions through an in-network retail pharmacy or the Express Scripts Pharmacy.

A previous study applied this social responsibility message to encourage injured workers to choose a generic equivalent medication. The results showed those who received the letter were 60% more likely to choose a generic than those who did not, despite the lack of personal financial incentive. We are applying the findings of our research and pilots to help payers save money and ensure better treatment outcomes for injured workers.

The Express Scripts Physician-Dispensed Medication Solution helps clients address the costly practice of physician dispensing while ensuring safe treatment for injured workers.

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