It feels as though the Worker's Compensation industry is at the mercy of the pharma cost cycle. In this cycle we see injured workers being prescribed opioid analgesics for pain and becoming dependent on or addicted to them only to require higher doses to keep pain levels under control. Not only does this create a substantially higher cost burden on Payers, but it is also detrimental to the long-term health of the injured worker. Pharma costs have become the runaway train with no one at the helm, leading Payers to wonder, "How do we curtail the pharmaceutical cost cycle?"
A Truly Effective Approach to Drug Utilization Review
Drug utilization review programs are a tool to help control the costs associated with large pharmaceutical claim costs as well as injured claimant outcomes. However, some drug utilization review programs are not as effective as others. Many are based on analysis work that overlooks important details and lacks in-depth jurisdictional and medical insight.Unfortunately, but all too often, drug utilization review programs fail to provide actionable treatment recommendations, let alone reductions in cost. To realize optimal outcomes, Workers Compensation Payers need to go a step further with a cost containment strategy that employs a Pharmacotherapy Review Program.
Results Through Collaborative Effort
Realizing concrete, actionable results requires a collaborative effort among stakeholders who share a common goal of achieving optimal outcomes for all parties involved.During the pharmacotherapy review process, a nurse expert evaluates the current treatment regimen of an injured worker. The expert nurse's professional knowledge base spans from intimate knowledge of injury specific medical treatments to state specific jurisdictional expertise. The assessment is based on current medical best practices and the medical information of the injured employee. This expert review is used to develop clinically appropriate recommendations which are then presented to the treating doctor.The newly proposed treatment plan, typically one that bypasses the inflated costs of pharma regimes, is agreed upon and endorsed by the treating physician's signature.
The implementation of the signed treatment plan is enacted through continued collaboration between the nurse expert and treating physician. This type of collaborative effort is especially crucial when alternative dosages or weaning of certain medications is recommended, as this often requires several months to achieve. A more cost-effective pharma plan is final out-come.
Looking After the Injured Worker
There is more to a pharmacotherapy review than just generating alternative, clinically-proven drug alternatives that can save Payers money. A quality pharmacotheraphy review also promotes the creation of a more responsible pharmacy industry that exclusively addresses the workers' injuries and utilizes clinical expertise and knowledge gained from reviewing the injured workers’ medical background and prescription history.Together, these factors reduce the possibility of creating cumulative, drug-related problems for the injured worker such as drug overdosing and adverse drug interactions. Collaboration between the nurse expert and the doctor issuing the prescription further promotes an action plan that supports the injured workers’ overall well-being.
ANS Solutions is an industry leader in Workers' Compensation medical cost containment. To find out more about our cost containment services including pharmacotherapy review, visit http://ans-solutions.com.
This blog post was originally posted on www.ans-solutions.com.
