Pharmacy Benefits Management
A Next-Generation Solution
Streamlines the entire claims process using robust and intuitive technology tools designed with input from experienced claims professionals
Maximizes savings through aggressive pricing and optimal cost containment tactics
Enables strategic decisions by leveraging artificial intelligence to analyze data and provide actionable insights
Drives better health outcomes with targeted clinical guidance that automates decisions when appropriate - and escalates decisions when necessary
Ensures easy access to care at minimal cost with a best-in-class pharmacy network and unsurpassed penetration strategies
Builds confidence and trust with complete transparency into pharmacy prices and cost drivers
Next-Generation Pharmacy Management
Current Rx Concerns in Workers’ Comp
Workers’ comp pharmacy management continues to evolve dramatically. Industry-wide reductions in opioid use and costs have given way to more nuanced – but still concerning – prescribing trends and cost drivers that present challenges for today’s payers.
Healthesystems is addressing the top priorities of today’s payers including:
Providing a better definition of, and visibility into, what you pay
Identifying risks that drive claim complexity and enabling early engagement
Automation & Efficiency :
Building more robust automation capabilities into the claims process
Delivering intuitive solutions that provide an optimal experience for claims teams’ and patients
We stand apart from the industry by providing exceptional pharmacy program management through our:
Transparency is essential to understanding the economic drivers within your workers’ comp pharmacy program. Lifting the shroud that often cloaks pricing and program performance details provides a more complete picture of cost dynamics throughout the pharmacy supply chain.
We provide a clear view into the economics and ROI of your pharmacy program, including:
Data & Analytics
The fragmented workers’ comp system isolates relevant information and obscures a holistic view of the patient, creating roadblocks to effectively assessing and managing injured worker populations and causing claims to unexpectedly escalate.
We capture, process, and analyze myriad disconnected facts and turn data into the visual, actionable information needed to glean insights and guide important clinical and operational decisions to help you:
Treating workers’ comp patients has become more complex. Comorbidities, psychosocial issues, and decreasing access to affordable care are impacting worker health and can lead to over-reliance on potentially harmful medications.
Our full-service clinical program stands apart from the industry with pharmacology and occupational health expertise embedded in our tools and workflows, along with high-touch services including:Learn more
Our integrated technology platform, Verticē, provides advanced tools for managing all Rx activity and a central connection point for communicating across the workers’ comp healthcare ecosystem that :Learn more
Our best-in-class network design provides a nationwide network of pharmacies, customizable mail order options, third-party bill management, and unsurpassed network penetration strategies that result in:Learn more
Key Benefits of Healthesystems Pharmacy Program
Identifies risks and reduces use of controlled substances and other concerning drugs
Simplifies claims processing and improves user and patient experience
Utilizes powerful data and analytic models to automate processes and inform decisions
Ensures appropriate and effective drug utilization
Minimizes out of network activity
Reduces physician dispensing, private-label and compound medications
Enables customized program strategies
Allows clear visibility into how pricing is structured and applied
While no clear link is established to these obesity and diabetes drugs, the FDA will continue to monitor data.
This sixth annual survey report highlights the top challenges and priorities of 500 industry professionals.
States so far include Alaska, Arizona, California, Hawaii, Indiana, Illinois, Massachusetts, Maryland, New Jersey, and Wisconsin.
Gain nuanced insight into your Rx drug activity, trends and opportunities through our complimentary consultative Rx e360 analysis.