Prescription drug costs continue to rise and have become a larger percentage of total health care expenditures for the workers’ compensation and auto insurance industries. In order to control rising drug costs, payers have realized savings through partnering with pharmacy benefit managers (PBMs). However, demonstrating measureable expenditure savings demands more than just a basic re-pricing of pharmacy claims. By breaking the management process into elements and treating each as a cost saving process, Healthcare Solutions’ approach yields far greater savings across the board and offers greater support, flexibility and reliability than do programs dependent entirely on price. The goal is simple: provide only appropriate medication for each person.

Healthcare Solutions’ pharmacy program is designed to manage prescription costs and enforce approved formulary guidelines while providing the injured worker/policyholder with convenient, hassle-free access to their medications while simplifying the job of adjusters.  Our services include:

• Initial Fill Pharmacy Services. From first-fill cards to dynamic enrollment, Healthcare Solutions’ program enables initial prescriptions to be filled without paperwork or out-of-pocket expense.

• Retail Pharmacy Services. Personalized pharmacy cards are provided to injured workers/policyholders for authorized medications.  Our comprehensive pharmacy network program is designed to be simple and convenient for prescription needs.

• Home Delivery Services. Offers patients on short-term or long-term recovery programs the option of nationwide home delivery of prescriptions.

• Clinical Rx™. An integrated approach to clinical management which proactively identifies key issues that significantly reduce the total pharmacy cost. By combining health care expertise with advanced technology, the program assists the injured worker/policyholder get back to work and back to life.

Healthcare Solutions’ approach to pharmacy benefit management is based on the use of technology, proven processes and comprehensive clinical management programs to address five key factors:

• Drug selection by the prescribing physician
• Identification of newer drugs without generic substitution opportunities
• Misuse and overuse of certain types of drugs
• High volume of prescriptions
• Multi-pharmacy/multi-physician involvement

At Healthcare Solutions, we ensure claimants are taking the proper medication and prevent inappropriate or non-compensable medication.  By monitoring physician behavior and integrating physician reviews into the prior authorization process, we ensure treatment plans are appropriate and address the needs of high dollar claimants – all while maintaining our focus on cost savings for our customers.

Contact a Healthcare Solutions representative to learn how we can assist your organization in meeting your Pharmacy Benefit Management needs.