White Paper

A Better Way to Manage Workers’ Comp Claim Decisions: 6 Steps to More Effective Pharmacy Workflows

Effective pharmacy workflows pair greater efficiency with better health outcomes, reducing burden for claims professionals while increasing impact.

White Paper Summary

For payers and claims professionals in workers’ compensation, pharmacy decisions have always required nuance. But the nature of that decision-making has evolved significantly over the last decade.

In 2012, more than half of workers’ compensation claims with prescriptions included an opioid. By 2021, that figure had fallen to just 26%, according to NCCI – reflecting a meaningful shift in prescribing patterns across the industry. Today, claims professionals must now navigate a broader range of medications, prescribing patterns, and pricing considerations.

For workers’ comp stakeholders, pharmacy isn’t just about managing overall cost. Claim duration and injured worker recovery also often hinge on nuanced pharmacy decisions –and those decisions must be carefully managed to ensure the best claims outcomes.

This is where pharmacy workflows come in. A successful workflow does much more than process prescriptions – it orchestrates how decisions are prioritized, informed, and executed within the broader claim context. The most effective workflows speed claim progression and increase efficiencies, all while driving better outcomes for patients. Let’s look at the six essential steps that should be part of every pharmacy workflow.

 

For more content like this from Healthesystems visit their RxInformer clinical journal website.

Healthesystems is a leading provider of Pharmacy Benefit Management (PBM) & Ancillary Benefits Management programs for the workers' compensation industry.

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