How Partnering with a TPA that Offers an Integrated Pharmacy Benefit Management Solution Can Reduce Your Workers’ Compensation Plan Costs

worker' comp PBM partnerAs a risk manager, you are focused on every aspect of your workers’ compensation plan that holds the potential to reduce your bottom line. As part of your responsibility to financially manage your organization’s cost exposure, one of your goals is to identify key strategic partnerships that can result in cost mitigation. By integrating a strategic pharmacy benefit manager (PBM) into your workers’ compensation plan, you have the potential to realize significant savings, as part of an effective pharmacy management strategy that can reduce overpayments of medical expenses. Consider the following benefits of choosing an integrated PBM model for your workers’ compensation plan:

The Benefits of a Strategic PBM

The cost of prescription drugs can easily be one of the most neglected areas of workers’ compensation cost control. It is estimated that on average, organizations spend $5 billion on drugs costs as part of their workers’ compensation plan each year. If your carrier or third party administrator (TPA) is not offering you a leveraged, strategic PBM partnership, you could be leaving money on the table.

Utilization Control

PBMs offer more than discounted drug costs. A truly strategic PBM will work with your TPA or carrier to identify trends in utilization, such as recurring prescriptions for opioids beyond the immediate recovery phase. Unfortunately, many work-related injuries involve managing chronic pain through the use of powerful, and potentially addictive, narcotics. An integrated PBM will also work with your TPA’s nurse case manager throughout the utilization review process to prevent the overuse of medications, such as narcotics. A singular, integrated PBM can also prevent injured employees from obtaining and filling multiple prescriptions for the same drug from multiple physicians or pharmacies.

Formulary Options

A valuable PBM partner will provide a comprehensive standard formulary that can be customized based on injury or patient in order to steer utilization to the most effective, and cost efficient medications.

Generic Substitutions

In many cases where a brand name drug is prescribed, a clinically-equivalent generic alternative can offer comparable outcomes for the patient, at a fraction of the cost. A strategic PBM partner will help to identify opportunities to speak with the patient and physician about a generic substitute.

Adverse Drug Interaction Avoidance

An integrated PBM with comprehensive visibility into all of the medications prescribed to a single worker can identify potential negative side effects of certain drug interactions, preventing potentially serious negative health risks.

Compliance Adherence

Each state has its own regulations regarding workers’ compensation plans. By partnering with an expert PBM that is well-versed in the regulations of your state, you can rely on the knowledge of its experts to help ensure your plan is compliant.

Network Access

The most valuable PBM partners offer vast national networks. With convenient access to pharmacies across the country, no matter where your employees are obtaining care, they can rest assured that they can obtain the prescriptions they need with the appropriate pricing.


        Mail Order Solutions

Without proper adherence to a prescribed treatment plan, an injured worker’s recovery and return to work could be delayed. Mail order solutions mitigate the risk for gaps in care, helping to ensure the injured worker is compliant with his prescribed treatment so that he can recover as quickly as possible.

Comprehensive Reporting

Under an integrated model, your TPA will aggregate prescription drug claim costs with medical claim costs to give you a holistic picture of the factors driving your workers’ compensation plan costs.

For more information on the benefits of integrating a PBM with your workers’ compensation plan, contact the risk management experts at POMCO today.