White Paper

PBMs Explained: What Roles Can Pharmacy Benefit Managers Play in Workers’ Comp?

How do PBMs help to manage the overall utilization, cost, and quality of workers’ comp healthcare?

White Paper Summary

With prescription drug spend representing less than 10 percent of workers’ compensation costs, the role of Pharmacy Benefit Managers (PBMs) is often viewed as niche – and sometimes this role is not well understood. As public discourse around PBMs in group health intensifies, it’s helpful to understand the goals and responsibilities of workers’ comp PBMs and the constraints under which they operate.

Put simply, PBMs manage pharmacy programs for the payers of workers’ comp claims. But their value goes far beyond transactional oversight. A good workers’ comp PBM will remove barriers to care, mitigate therapeutic risk, and create workflows that make it as easy as possible for injured workers to recover – guiding pharmacists, physicians, and claims professionals through a complex system where every decision must align with regulatory requirements and evidence-based care. These objectives reflect an expanded role versus group health, where this level of complexity simply doesn’t exist – and where PBMs may be focused on other priorities.

 

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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