White Paper

Coming Up Short: When Drug Shortages Become a Claims Problem

Drug shortages are no longer just a pharmacy issue but a growing claims management risk in workers’ compensation, contributing to more complex claims, delayed care, and higher costs.

White Paper Summary

For more than two decades, drug shortages have plagued the U.S. healthcare market – so much so that the American Medical Association has declared them “an urgent public health crisis.” Because 84% of shortages involve generic drugs, they have a disproportionate impact on injured workers who rely on these generics for early pain control and post-surgical recovery.

And in workers’ compensation, shortages are no longer simply a problem at the pharmacy counter – they are increasingly becoming claims management risks. Medication access delays can alter claim trajectories, resulting in worse health outcomes and prolonged time away from work. On the administrative side, these cases can quickly escalate into more complex, higher-touch claims requiring increased oversight and intervention from claims teams.

To keep claims on track, payers and claims professionals must take a proactive approach – one that involves the ability to anticipate risks, maintain visibility across the claim lifecycle, and coordinate clinical and pharmacy decisions in real time.

 

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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