Pharmacy Benefit Management

Best-in-Class Pharmacy Benefit Management Solution

Our comprehensive Pharmacy Benefit Management (PBM) solution for workers’ compensation sets new standards for value and performance. We go beyond processing prescription drug transactions to aggressively manage drug utilization and control pharmacy spending. By integrating clinical expertise and advanced technological capabilities, we eliminate cost drivers while ensuring that injured workers receive quality care.

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    The right care.

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    At the right time.

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    For the right cost.

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    Our focus is targeted

    We are workers’ compensation industry experts

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    Our solutions are unique

    We customize our solutions to our clients’ unique needs

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    Our technology is innovative

    We deliver prospective management and real-time access to data

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    Our approach is proactive

    We identify and address emerging issues to prevent claims escalation

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    Our customer service is exceptional

    A dedicated account management team and 24/7 customer service center support our clients’ needs

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    Our mission is clear

    We simplify the complexities for each customer

A Simplified Solution

Healthesystems simplifies the complexities in pharmacy benefit management. Our unique PBM solution incorporates sophisticated clinical and financial strategies, advanced analytics, and innovative technology. Our program streamlines processes, drives network penetration and manages drug utilization and costs, regardless of the source.

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  • Manual tasks are replaced by automated workflows that reflect client requirements and evidence-based medical guidelines.
  • Injured workers are managed in network from the onset with our First Fill program.
  • Real-time data exchanges with over 61,000 network retail pharmacies increase network savings and minimize paper bills and associated costs.
  • Prescription drug transactions are consolidated into a single patient record whether billed by retail pharmacies, doctor’s offices, third party billers or mail order services — for increased clinical oversight.

Aggressive Management

We aggressively manage drug utilization and focus on the most complex cases to reduce the total cost of care and improve treatment outcomes. We stay ahead of these and other hidden cost drivers by developing strategies and tools to minimize these challenges such as:

  • Opioid therapy issues
  • Physician dispensing
  • Inappropriate prescribing
  • High-cost specialty drugs
  • Compounds
  • Polypharmacy
  • Signs of fraud, waste and misuse

Robust Tools

Our Vertic─ô web-based claims portal is an indispensable resource for claim professionals. It alerts them to claims needing close attention and provides robust reports, clinical guidance and easy-to-use tools that empower them to make informed decisions.

Significant Savings

Our innovative PBM solution reduces the overall cost of drug therapy through:

  • Streamlined process
  • Maximized network penetration
  • Improved utlization management

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