White Paper

How to Rein In Physician-Dispensed Pharmaceuticals in Workers’ Comp: A Path Forward

Physician dispensing has become a persistent cost and safety challenge in workers' compensation. Here's how the industry and policymakers can work together to address it.

White Paper Summary

Physician-dispensed pharmaceuticals have long occupied a contentious space in workers’ compensation. What may start as a convenience for an injured worker can lead to stark cost differences. For example, a topical cream dispensed from a physician’s office for $1,200 could cost under $65 at a retail pharmacy, while a repackaged medication billed at over $250 might sell for less than $10 for a nearly identical bottle at the corner drugstore.

But for payers, third-party administrators (TPAs), employers, and pharmacy benefit managers (PBMs), the challenge isn’t just financial. It’s also clinical. When medications flow through multiple providers with no centralized view of treatment, patient safety concerns emerge alongside the cost issues.

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The Optum workers’ compensation and auto no-fault division works to collaborate with our clients to deliver value beyond transactional savings while helping ensure injured parties receive safe and effective clinical care throughout the life of their claim. Our innovative and comprehensive cost management programs include pharmacy care services, ancillary benefit management, medical services, and settlement solutions.

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