Pharmacy Benefits Program

Three Advantages to a Pharmacy Benefits Program

1. It helps keep costs down.

A pharmacy benefits program acts as an intermediary between the insurance carrier and everyone else involved in the claim, including employers, employees, drug wholesalers and pharmacies. A pharmacy benefits manager can also negotiate lower costs with pharmacies and drug makers.

In addition to their negotiating leverage, a pharmacy benefits manager can also help control claims costs by directing patients to generic versions of prescribed medications, rather than the more expensive brand-name versions. According to some estimates, generic drugs can cost 80 to 85 percent less than the brand-name drugs.[2] Pharmacy benefits managers can also help make sure prescriptions are filled in-network and that the prescription medication component of the overall claim cost is appropriate. These saving can help keep premiums lower for policyholders.

2. It helps manage against drug abuse or overuse.

Schedule II prescription drugs, which include opioids, are often a reasonable and appropriate part of a treatment plan for workplace injuries, including management of general pain, chronic pain and pain related to surgery. Although opioids are sometimes prescribed for long-term pain relief, medical guidelines indicate their effectiveness could decline over longer periods as patient tolerance increases.[3]

For every claim involving prescription drug treatment, the pharmacy benefits program manager examines three key criteria before approving dispensation:

  1. Is it an appropriate drug to treat the claimant’s injury?
  2. Is it an appropriate dose?
  3. Will it cause a potential drug interaction with other medications the claimant takes?

The extra level of scrutiny before a prescription is authorized can help reduce the likelihood of a patient getting addicted to pain medications as a side-effect of a workplace injury.

3. It gets employees back to work faster.

The target outcome of every workers’ compensation claim is to help the employee heal and get back to work as quickly as medically appropriate. Employee injuries are costly to small business owners in many ways, including reduced productivity, lowered employee morale in co-workers who must pick up extra hours, and premium. In addition, studies show that the longer an employee is away from the workplace, the less likely he or she is to return.[4]

By dispensing the correct medication for the appropriate amount of time, patient recovery and healing may be hastened, helping get employees back on their feet. As the prescription drug marketplace continues to evolve, insurers are increasingly implementing pharmacy benefits programs to help control costs and help workers get the care they need to safely return to work as soon as they are able. For more information on the benefits of this program, contact an agent or carrier today.

[1] United States Department of Labor, Bureau of Labor Statistics, “Employer-Reported Workplace Injury and Illnesses, 2016,” Nov. 9, 2017.
[2] Harvard Health Publishing, “The cost of generic and name-brand drugs – Harvard Health.”
[3] Opioid Overdose, Oct. 3, 2017.
[4] Orslene, L. E., “Accommodation and Compliance Series: Return-to-Work Programs,” March 18, 2013.