How can organizations trim workers' compensation costs while getting every bit of that intangible peace of mind? Tina Preisig, senior vice president of managed care for PMA Cos. and author of the company's new white paper, "The 1-2-3 of an Effective PBM," explains one of the surest ways to control, and perhaps reduce, your total workers' compensation cost is to make certain your insurance carrier or TPA works with an effective, results-driven pharmacy benefit manager.
"Workers' compensation is a vital part of doing business for any organization," Preisig says. "Now may be the time to revisit your program and find out whether or not your PBM is achieving as much as possible for your injured workers and your organization's bottom line."
- Discounted rates on prescriptions. Through established direct contracts with national retail pharmacies, PBM programs can negotiate significantly discounted rates on prescriptions for injured workers.
- Maximizing network penetration. A pharmacy network is a group of retail pharmacies that provides discounted rates on prescriptions negotiated by your PBM. Effective PBMs employ strategies to maximize network penetration.
- Generic conversion. Generic transactions represent approximately 65 percent of prescriptions, and with generic cost differentials of 20 percent to 40 percent lower than brands, substantial savings opportunities exist.
- Appropriate use of mail service. Mail-order pharmacy for workers' compensation has proven to achieve an industry benchmark of 8 percent to 12 percent cost savings over traditional retail environments, and advanced mail-order programs can achieve a 20 percent to 25 percent cost savings.
- Customizable formularies. An established formulary will be well researched and therefore, able to help control and monitor prescription utilization, duration and cost, and should be customizable to clients' specific needs.
- Effective utilization management. An effective PBM should have online, real-time tools for utilization management. An interactive reporting platform can retrieve and analyze program trends, as well as critical claims, enabling claims adjusters to make more informed decisions instantly.
- Innovative clinical management. The PBM should have clinical reviews and system alerts to help ensure immediate communication takes place when potential emergencies or treatment complications occur.
- Insightful data and reporting. With flexible Web portal reporting, providing dashboards, scorecards and graphs, PBMs now offer greater insight into program performance.
