When it comes to technology in today’s workers’ compensation world, “real time” often can have more than a single meaning, but only one really works. And while technology has evolved to where it is a fairly common service offered by many PBM’s and ancillary medical services providers, the difference between how “real time” is applied becomes the primary variable to determine the ultimate benefit and value of these tools. Many new Web portals may offer a slick interface, but not all of them have the power “under the skin” to provide what payers need to maximize program savings and overcome the key challenges associated with managing these types of services.
Time is money – in the case of pharmacy benefits, whether it is the early detection of inappropriate and costly
prescription treatments, the ability to quickly address point of sale (POS) prescriptions requiring prior authorizations to deter them from processing out-of-network , or reducing the amount of time claims professionals spend on managing prescription benefits, each challenge can be greatly minimized by processing information faster. All of these issues need to be resolved to achieve the best program results.
As is the case with any workers’ comp pharmacy benefit program “you want all point of sale prescription transactions to be prospectively adjudicated, where all the clinical rules, pricing, eligibility, etc., are applied before the product or prescription is provided,” says Daryl Corr, president of Healthesystems, the Tampa, Fla., PBM. “That’s one of the most basic functions of any effective PBM program.”
To get there, Corr explains, requires a PBM ...read more