Pharmaceutical Solutions

“Narcotic abuse and Workers’ Compensation.”

OMCA provides PharmCLEAR® and Pharmacy Benefit Manager (PBM) value-added services to carriers, third-party administrators and self-funded employers on a nationwide basis.

No area of Workers’ Compensation medical costs is increasing as fast as prescription drugs, causing complex and post-award cases to exceed reserves and new cases to spiral out of control.

The OMCA PharmCLEAR® program offers several levels of services with increasing intensity to help control escalating and abusive pharmaceutical costs.

General Pharmaceutical Review
The pharmaceutical review is developed by OMCA nurse and/or PharmD reviewers detailing usage and reasonableness in keeping with best practices. OMCA will provide a written report detailing medication utilization and recommendations for more effective medical management of the file.

Physician Review
The next step is for a physician advisor to write a comprehensive report with recommended course of action.

Our board certified physician advisor personally contacts the treating provider to discuss a recommended change in the current medication management plan. The goal of this contact is the implementation of a more effective, less costly drug regimen.

Extended Review
Our clinical staff assumes management of the case for an agreed upon time. Typically, this will coincide with the injured worker’s demonstrated acceptance of the new treatment plan and may involve case management intervention to deal with medical issues relevant to that change (e.g. detox and addiction issues).

PBM Services
PBM programs are an important step in controlling Workers’ Compensation medical costs. However, PBMs are not a panacea for pharmaceutical problems. OMCA is uniquely skilled to help clients pick the right PBM vendor.

For more information about Workers’ Compensation services, contact OMCA at (800) 633-5960 or