Advanced Strategies for Pharmaceutical Cost Management

With large loss claims, the road to managing the hefty costs associated with pharmaceutical therapies can be long and winding. As more drugs become available within drug classes, there is often a large cost disparity among medications. Further, patient access to more affordable and equally (if not more) effective medications is limited. Fortunately, there are advanced pharmaceutical cost management solutions available. One such solution, Pharmacotherapy Review, is ANS’s highly evolved approach to drug utilization review. The Pharmacotherapy Review Program utilizes a three-stage approach to provide economically balanced and appropriate treatment options for injured workers.

PharmReview – Stage 1

At ANS we are not just concerned with cost-effective treatment regimes. Overall our strategies strive to improve the quality of life for the injured worker. The PharmReview program applies evidence-based medical guidelines when strategically assessing each case to identify the best possible clinical and pharmaceutical treatment plan based on the injured worker’s medical condition. The final product is an expert recommendation on a course of action to improve the living conditions of the injured worker while reducing unnecessary costs for the carrier.

PharmIntervention – Stage 2

PharmIntervention involves applying expert clinical knowledge and experience in catastrophic injures to recommend, where appropriate, alternative treatments and therapies. The goal of this strategy is to improve quality of care and overall outcomes. Achieving this goal requires a thoughtful and collaborative partnership between treating physicians to employ a modified treatment plan based on the recommendations of highly credentialed and experienced nurse experts. When done correctly it will ensure that patients receive the highest quality of care balanced with the necessary cost controls.

PharmCompliance – Stage 3

Physician and patient compliance with the new prescription plan established during the PharmIntervention stage is crucial to a successful pharmaceutical cost management strategy. First, it will help determine whether the modified treatment plan is achieving the desired result. Second, it will ensure both the physician(s) and injured worker are actively engaged in the new treatment regime. Compliance by both parties will generate hard dollar cost-savings and positive therapeutic outcomes. In this stage, ANS Clinical Liaison officers will pro-actively manage a case to ensure compliance and maximize outcomes.

ANS Solutions

Effective use of advanced pharmaceutical cost management tools such as ANS PharmReview Program can minimize overall costs, improve patient access to more affordable medications and provide an improved quality of life. Our pharmaceutical cost containment strategies have achieved proven results time and time again. To find out more about our medical cost management services visit us at www.ans-solutions.com.

Content originally posted at www.ans-solutions.com.

The Financial Repercussions of MSAs on Large Loss Claims

Medicare recommends an allocation of funds in a Workers’ Compensation settlement that is set aside to ensure that the injured party’s qualified medical expenses are funded, also known as Medicare Set Aside. These funds must be used to pay for treatment related to the Workers’ Compensation injury, that would otherwise be paid for by Medicare. The financial repercussions of MSAs on settlements can be significant.

Part D Exposure

As part of the Medicare Modernization act of 2003, Medicare indoctrinated what is known as Part D prescription drug coverage beginning in 2006. In other words, an allocation must be made for future prescription drug treatment in a Medicare Set-Aside. Rising pharmacy costs, including medications an injured worker may have been prescribed once in the previous 2 years, along with treatment, has created an environment in which Payers are subject to unreasonably high claim settlements.  The “Prescription Affliction” suffered by Payers is lovingly referred to as Part D exposure and it leads to claims staying open longer or not settling at all. As a result, these claims rack up millions of dollars in cost for Workers’ Compensation Payers.

Reducing Medicare Set Aside and Part D Exposure

A proactive approach is necessary before settlement and preferably early in the process for optimal results. At ANS, we mitigate Medicare Part D exposure with a three pronged approach:

• PharmReview – during this stage, the injured worker’s existing pharmaceutical regimen is assessed and modification recommendations are determined.
• PharmIntervention – a face-to-face discussion with the treating physician to achieve consensus on a modified medication regimen and commitment on a future course of treatment.
• PharmCompliance- an ANS Clinical Liaison Officer ensures compliance with the new prescription treatment plan. This provides a proactive management of the case to optimize hard cost savings.

Only highly credentialed legal nurse experts who are experienced in the treatment of catastrophic injuries, such as those employed by ANS, can provide actionable recommendations based on the individual patient and engage effectively with treating physicians. This technique yields a clear medical action plan that drives down costs while simultaneously improving the quality of care for the injured worker, allowing for reasonable settlement of the claim.

ANS’s pharmaceutical cost containment technique has reduced pharma costs by up to 25%. To find out more about reducing MSA and Part D exposure, contact us today.

This post was originally published at http://ans-solutions.com/.