Why Businesses Should Use a Single Vendor for Their PBM and Settlement Solutions Programs
White Paper Summary
It’s no secret that medication spend is a huge driver of costs in workers’ compensation. The medications an injured person takes are often critical to their recovery process, but if they’re not prescribed in the right doses — or worse, if a person is taking medications that are not appropriate for their care — costs throughout the claim life cycle can spiral quickly.
Many companies choose to work with a pharmacy benefits manager (PBM) that helps ensure the appropriate clinical care of the injured person and works with pharmacies and drug manufacturers to help manage medication costs for clients.
Even with a PBM, managing costs can be tricky, especially when it comes to managing Medicare Secondary Payer Compliance (MSP). In accordance with the MSP Act, insureds need to set aside funds, typically in the form of an MSA, if an injured person is a Medicare beneficiary or is likely to become Medicare-eligible within 30 months. This helps ensure that the care costs for a workers’ compensation claim are not shifted onto Medicare. Approximately 10% of every 100 injured persons are Medicare beneficiaries.
To help manage those costs, in addition to working with a PBM, insureds should consider teaming up with a settlement solutions program that focuses on making sure they’re prepared for Medicare Set Aside (MSA) costs.
By thinking about the end of the claim from the beginning, a coordinated PBM and settlement solutions program benefits both the insured and the injured person.
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