In workers’ compensation, pharmacy network utilization has always been an evolving challenge. For a variety of reasons, injured workers in some states are filling their prescriptions via out-of-network (OON) channels – most often through physician dispensing or OON mail order pharmacies – a practice that negatively impacts payers and even the patients themselves.
Injured workers are frequently in the dark about OON prescription drug channels and the ramifications of bypassing network retail pharmacies. In the case of OON mail order pharmacies, they may choose them for sheer convenience. Other times, it may be frustration with prescription delays or even denials that are contributing to their choices. And in cases of physician dispensing, which is prescriber-driven behavior, the injured worker may not even realize they have the option to request a written prescription to take to their local pharmacy.
Because OON activity is driven by many factors, managing it requires a nuanced, multi-pronged approach. One important component of this approach is direct engagement with the injured worker. In addition to empowering injured workers to take a greater role in their own care, we’ve also seen that it can play a positive role in driving pharmacy network utilization.
Continue reading the article in full at the Healthesystems Blog.
