Unnecessary Drugs at Very Good Prices
Sometimes when driving, I’ll get lost. Like most men I am reluctant to ask for directions. When my condition is pointed out by my wife (without fail) I will respond, “I may be lost but I’m making great time”. So many carriers have great deals with Pharmacy Benefit Managers (PBMs), receiving impressive discounts on their pharmaceutical purchases.
Unfortunately, these discounts are for drugs they shouldn’t be buying in the first place. Post-award medicals are the great black hole of workers’ compensation medical expense; pharmaceuticals are the fastest growing component of this abyss. Often, this is because drugs are on autopay and/or the carrier is depending upon its PBM to monitor these charges. Remember, the PBM makes no money unless it sells drugs. Granted the price schedule for what you buy may be attractive but, often, you shouldn’t be buying in the first place.
PBMs and their pharmacists will warn you about drug interactions, or attempts to refill dnigs too soon, but they don’t point out that the opioid being prescribed 3-years post surgery, while safe, should have been stopped some 2 % years earlier. They may identify appropriate generics but don’t tell you that the use of that particular drug could not be reasonably related to this specific work-related injury. Or that taking multiple drugs, though safe, may indicate a condition for which the carrier would not be responsible (e. g. diabetic neuropothy, depression, etc.), PharmCLEAR® physician advisors are experts at pharmacy.
Let us audit your PBM statement and make sure you’re paying for only those drugs that are scientifically related to the injury for which you are responsible.
We can do better.
William V. Faris, JD
Posted in Medical Cost Containment, OMCA, Workers’ Compensation