A single workers’ compensation claim has several moving parts: scheduling appointments, return-to-work strategies, keeping all stakeholders informed and more.

Pharmacy management is another piece of the comp puzzle that must be addressed. Brand drugs and other prescription practices used in workers’ compensation can quickly drive claims costs if they’re not managed effectively, and minimizing patient risk and reducing pharmacy spend should go hand in hand.

“Injured employees waiting at the pharmacy for their medications can become a significant pain point,” said Sarah Scott, vice president of network services for CorVel.

“Likewise, not having a clear view of the best pharmacy management solution strategy can slow down the process and become costly,” both in terms of the actual price tag and in terms of patient recovery.

Finding a pharmacy management solution does not need to feel like an added chore. According to Scott, there are three key elements that make up a good pharmacy solutions partner: transparency, cost efficiency and customization.

Here’s a deeper look at these three traits, why they are important when it comes to pharmacy management in workers’ comp, and the added benefits of finding a solution-driven pharmacy management partner.

1) Transparency and Service Excellence

Good communication is always appreciated, no matter the discipline or industry.

In workers’ compensation — and specifically pharmacy management — effective communication is demonstrated through transparency in costs, performance and clinical engagement.

“At CorVel, we give clients full visibility into medication costs and promote fair pricing strategies. In jurisdictions with medication fee schedules, we offer our clients pricing at or below the fee schedule. Additionally, we don’t promote or take rebate credits on brand medications,” Scott said.

“We want our clients to have complete transparency into what we’re paying for medications and ensure that we’re fairly compensated for our management and activities,” she added.

This is done in an effort to eliminate unwanted surprises throughout the process. It’s also done to show that pharmacy management solutions can be tailored specifically to the needs of the workers’ compensation space.

Workers’ comp can be a complex industry, and any workers’ compensation partner must have the skills to navigate the space effectively. Transparency in pricing and performance is a great start, but true mastery comes with the people supporting these efforts. That’s why good communication in customer service must be weighted equally to transparency.

CorVel has worked to create a team ready to address the many needs of patients throughout their pharmacy journey.

“Given the complexity of workers’ comp, one of the ways we’ve worked toward great customer service is by ensuring that our entire pharmacy team, from customer service representatives to management, are certified pharmacy technicians,” said Scott.

In addition to certified pharmacy techs, the team comprises PharmDs and pharmacy nurses, fostering a patient-centric clinical approach to care that ensures safe, appropriate and cost-effective medication management.

“We believe it’s critical that the team has the clinical knowledge in the space they’re working in and can effectively communicate with the clinicians they interface with,” said Scott.

2) Pharmacy Spend Reduction and Efficiency

Being up-front and transparent goes a long way in pharmacy management and patient recovery. The next step in the process is having a partner that actively finds ways to reduce costs where appropriate.

Scott shared that CorVel approaches pharmacy spend reduction in several key ways: through strategies like maximum network penetration, custom formulary management, generic substitution and aggressive utilization management.

“When we say ‘maximum network penetration,’ we’re referring to maximizing the volume of prescriptions that go through our pharmacy network, allowing us to control and manage them proactively,” she explained.

CorVel does this to ensure prescriptions are appropriate and safe for the injury in question while also keeping a finger on the pulse of out-of-network prescriptions that can be redirected back in-network to better manage their cost.

Regarding custom formulary management, Scott said that the team offers formulary customization at various levels. For example, “at the client level, we can have a custom formulary where the customer specifies which medications should be approved and which require prior authorization,” she said.

“We can also customize at a granular level for individual claims. This custom formulary management allows us to tailor the formulary to the specific needs of clients and individual claims.”

These efforts further reduce time to fill because they enable the client to decide which specific medications are paid up front. Another key saving approach is that the formulary itself is universally generic, meaning any brand name medications must receive prior authorization before being dispensed.

Finally, Scott said, utilization management can be used to make sure the medications and other treatments administered are appropriate for the individual claim. This is something that’s particularly important in the management of opioids, high-cost prescription topicals or specialty medications.

“As a team of health care professionals, it is our job to work together to identify what treatment an individual requires to make a full recovery,” Scott said. “Staying ahead of every single new and upcoming medication is indeed challenging, but within our organization, we focus on staying informed about these developments … to provide the best possible service to our clients and the individuals on the claim.”

3) Customization and Integration

The final trait of a good pharmacy management solution partner is an ability to customize its services to match the needs of its clients.

The CorVel team has worked to tailor its solutions to meet the unique needs of each client, as seen in its ability to allow the client to decide which drugs can be paid up front and which require prior authorization.

When taking it one step further, said Scott, “integration is a key component.”

CorVel looks at the different elements of a prescription, like out-of-network spending, state formularies and fee schedules, and brings them together into its workflow, all in an effort to streamline processes and deliver efficient solutions to clients.

“We offer a variety of integrations, but the most impactful is the ability for clients to click into our system and view key medical components of a claim to assist in determination of prior authorization,” she added. “During this process, they have full visibility into the medical spend and access to information on previously dispensed medications from prescribers.”

Bringing Pharmacy Management Solutions Under One Roof

With over 35 years of experience in the workers’ compensation space, CorVel not only demonstrates the key traits of a pharmacy management solutions partner — its team lives by them.

“We aim to provide tailored solutions that address the specific needs and challenges our clients face. Our approach is centered around the specific nature of each case, considering the particular injury, task and employment context of the individual in the claim,” said Scott.

“This targeted focus creates natural guardrails that ensure we deliver the most appropriate and effective care for each individual.”

CorVel has put in the time and effort while acquiring the resources to provide clients with a comprehensive formulary focused on medications needed for recovery. It has made this process as transparent as possible, and offers 24/7 access to customer service should a question arise.

“Our pharmacy management solution goes beyond cost reduction,” said Scott. “We actively offer a transparent, efficient and client-centric approach to pharmacy management, placing our clients’ needs and the injured employee’s care at the center of what we do.”

To learn more, visit: https://www.corvel.com/services/workers-compensation/pharmacy-benefit-management.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with CorVel. The editorial staff of Risk & Insurance had no role in its preparation.