Pharmacy Benefit Management (PBM)
An Effective and Efficient Pharmacy Program
Pharmacy costs represent one of the largest portions of total medical spend for treating injured workers and the complexities involved with managing workers’ compensation prescriptions have always been challenging for many payers. High touch service, attention to detail and powerful technology are crucial to reign in this fast growing medical expense.
Our leading Pharmacy Benefit Management (PBM) Program employs innovative technology and clinical expertise to improve claims outcomes and reduce the total cost of prescription drugs, all while providing the highest level of care for injured workers.
The Healthesystems pharmacy program offers much more than the administration of pharmacy transactions at reduced prices. It provides customers with a comprehensive approach to reduce the total cost of medical care and minimizes the claims management administrative burdens. We employ a highly efficient and automated technology platform to streamline the Rx prior authorization process and improve communication — resulting in improved claims outcomes, increased provider network penetration and lower prescription drug costs.
Our Pharmacy Benefit Management Program includes:
:: Comprehensive Drug Utilization Reviews on all prescription transactions
:: Customizable medication plans
:: Innovative tools and processes to minimize third-party bills and paper bills
:: Access to our proprietary, web-based claims information portal, Vertice
:: A pharmacy network with more than 60,000 locations including major pharmacy chains
:: 24/7 Customer Service Center to assist pharmacies, claims professionals & patients
:: Integrated clinical review programs
:: EDI and state reporting
:: Mail order services
:: Customized reports and data analytics for trending and performance benchmarking
These building blocks of the PBM program, coupled with our extensive clinical expertise and powerful technology, provide a robust program focused on providing quality care — all while helping our clients manage the rising cost of medical and pharmacy services.
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