Pharmacy Benefit Managers (PBMs) are an integral piece of managing the overall utilization, cost, and quality of workers’ compensation healthcare. With prescription drug spend representing approximately 7% of workers’ compensation medical costs, PBMs like Healthesystems are most known for leveraging our technology, clinical expertise, and pharmacy networks to negotiate drug prices, manage formularies, and process prescription drug transactions on behalf of our payer clients.
“On behalf of” is a key phrase here, as we are sometimes viewed as middlemen in the workers’ compensation drug supply chain. However, PBMs can be much more than that, as this position comes with some opportunities to interact with stakeholders across the workers’ comp healthcare ecosystem and ease their experiences.
“Workers’ comp is a high-touch business, and there’s necessity in everything we do,” says Mike McCord, Healthesystems Vice President of Account Management. “PBMs have a significant opportunity to create an exceptional experience for all stakeholders – from the executives and program managers at claims organizations, to their claims staff, to the injured worker.”
Here are four ways PBMs can improve the workers’ comp experience for everyone:
#1. Reducing burden for payers
Workers’ compensation payers often partner with numerous vendors, including a PBM, to enable the multitude of strategies needed to run a high-performing medical management program. “As a vendor, the goal is twofold,” says McCord. “Provide a high level of strategic and executional value while minimizing any ‘noise.’ The last thing you want to do is add to your client’s headaches. Your focus should be on easing or removing complexities and friction wherever you can, while showing up every day to help enable their goals and visions.”
Continue reading the article in full online at the Healthesystems blog.
