Sophisticated Tools Cut Comp Pharmacy Costs.MADISON, Conn. -- Sophisticated cost controls are reducing workers' compensation workers' compensation, payment by employers for some part of the cost of injuries, or in some cases of occupational diseases, received by employees in the course of their work. pharmacy costs, according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. Health Strategy Associates' "Fourth Annual Survey of Prescription Drug prescription drug Prescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug, Management in Workers' Compensation." For the second consecutive year, Atlanta-based Cypress Care sponsored the survey of large and medium workers' compensation payers. Twenty-one respondents, whose combined 2006 drug spend of $1.01 billion represents one-quarter of all workers' compensation drug costs, reported a pharmacy cost increase of 6.5 percent between 2005 and 2006, compared with an 18 percent increase cited in 2003. Despite significant price increases in 2006, there was a three-point decrease in the rate of pharmacy cost inflation from 2005 across all respondents. "Investing in utilization management Utilization management is the evaluation of the appropriateness, medical need and efficiency of health care services procedures and facilities according to established criteria or guidelines and under the provisions of an applicable health benefits plan. tools, more and better data mining and analysis, and addressing third-party billers is paying off," observed HSA's Principal Joseph Paduda. One participant actually decreased its drug spend by eight percent, while another reported a 20 percent increase. Payers experiencing higher costs attributed inflation to higher utilization, physician prescribing behavior, the over-use of pain medications, and higher unit prices. The inability to capture the initial prescription in-network, off-label dispensing of high-powered pain medications, physician dispensing and repackaged drugs, and third-party billers (TPBs) also directly affected total drug costs. Certain practices appear linked to the dramatically improved results enjoyed by some payers. Medical advisors addressing problematic scripts and prescriber behavior, providing adjusters and clinical staff with basic training on drug issues and trends and access to high-level clinical support when needed, carded programs, and processing all scripts through a Pharmacy Benefit Manager (PBM PBM - play by mail. See play by electronic mail. ) to consolidate data, enhance network steerage steer·age n. 1. The act or practice of steering. 2. Nautical a. The effect of the helm on a ship. b. The steering apparatus of a ship. c. and penetration, and identify non-compliant pharmacies, were proven cost controls. About Cypress Care Privately-held Cypress Care www.cypresscare.com provides pharmacy benefits management and health care benefits to multiple industries including workers' compensation, Medicare Set Aside and auto markets. Its award-winning best practices help insurance carriers, third-party administrators, governmental entities, and self-insured employers achieve the best financial and clinical outcomes by helping individuals return to work. The company was the Winner of the 2005 PBMI PBMI Pala Band of Mission Indians (California) Rx Benefit Innovation Award. About HSA HSA Health Savings Account (US) HSA Human Serum Albumin HSA Human Services Agency (Nevada) HSA Health Services Agency HSA Health and Safety Authority (Ireland) Led by Joseph Paduda, HSA (www.healthstrategyassoc.com) is a national consulting firm serving insurers, employers and health care providers. Pharmacy costs and similar issues are covered in Paduda's blog, www.ManagedCareMatters.com and study results are available by contacting helen@kingknight.com or 813-837-1701. |
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