Comprehensive Pharmacy Review

Did you know that workers’ compensation medical costs per claim average more than $6,000 and increase to nearly $25,000 for lost-time claims? Or that prescription drugs make up approximately 19% of workers’ compensation medical costs? For those claimants on chronic pain management, opioid abuse occurs in up to 41% of patients.

You need to take control over your medical spend on pharmacy costs. Our dedicated service unit, staffed with experienced professionals, will coordinate peer-to-peer consultation, negotiation, agreement, and concurrence letter. To ensure a successful outcome, case management follow-up and intervention is a must. 

This Solution Helps Mitigate

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Regulatory Changes & Fines

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Lost Time & Productivity

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Control Medical Costs

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Adjuster Overload

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Siloed Data

Reduce Medical Expenses

In-depth analysis of treatment plan and pharmacy utilization

Comprehensive Pharmacy Review (CPR) is a detailed clinical analysis of a claimant’s pharmacy utilization and prescribing provider’s treatment plan followed by peer-to-peer outreach. This includes review of:

  • Current treatment patterns
  • Recommendations for future prescribing patterns
  • Provider education on evidence-based medical guidelines recommendations
  • Relevancy of these recommendations to the ongoing medication regimen
Genex’s clinical interventions yielded a 43% decrease or discontinuing of medications for one large carrier.

 

Achieve Better Outcomes

Specialized team of board-certified, active practice peer reviewers with enhanced pharmacological experience

Board-certified peer reviewers will determine medications that are appropriate for the claim. They will facilitate weaning off, tapering and discontinuation of unrelated and/or inappropriate medication. Our peer reviews will also ensure pharmacological management is consistent with appropriate evidence based guidelines related to Schedule II Drugs or opioid dosing.

70% success rate in achieving peer-to-peer contact 47% of treating physicians agreed to wean or taper.
Reduce Medical Expenses

Transition to optimal treatment plan

Experienced peer reviewers will work in partnership with the prescribing physician to transition the claimant to an optimal treatment plan. A Genex case manager will education and promote compliance with the negotiated treatment plan.

Need to reduce your total cost of risk?

To help lower your total cost of risk and return injured workers to work as quickly as possible, we offer a FREE consultation with a workers’ comp expert. Together, we will begin to build a workers' comp program to meet your company’s unique needs.