Industry leading network penetration results and clinically based outcomes

Pharmacy Benefit Management (PBM) for workers’ compensation is one of PMSI’s core competencies. PMSI has the clinical expertise, analytical tools, and industry knowledge—combined with extensive experience processing millions of pharmacy transactions—to provide best-in-class solutions that are comprehensive, yet flexible to meet our clients’ pharmacy needs.

Our total PBM solution, PharmaComplete™, addresses key industry challenges that impact quality and spend in pharmacy programs: network penetration, unit cost, utilization, administrative costs, compliance, and service quality. Comprised of customizable, proprietary strategies that address all aspects of pharmacy transactions, PharmaComplete integrates clinical oversight with a holistic view of medication usage. Clients receive reliable data with clinically based recommendations in order to make informed decisions that drive optimal health outcomes for injured workers.

PMSI’s owned network of nearly 65,000 retail pharmacies nationwide offers convenience and service for the injured worker, and customization opportunities for the payor. The Retail Pharmacy program, known as Tmesys®, includes national chains and independent outlets, as well as partnerships to increase in-network transactions through Automated Re-indexing. Other components, such as First Fill, Pharmacy Card and Samaritan Dose, help ensure transactions are easily captured in-network at the point of sale. The Retail Pharmacy program is supported by over 100 customer-care professionals who are intimately familiar with the needs of injured workers, pharmacists and payors—providing 24/7 customer support, 365 days a year.

PMSI’s Mail Order Pharmacy program enables injured workers to receive their necessary medications securely at their home, without having to make a trip to the pharmacy. By providing this convenient option for injured workers, payors benefit from reduced costs and simplified claims administration. The Mail Order Pharmacy program provides a high level of personalized service and is staffed by a full complement of registered pharmacists and supporting pharmacy technicians, all of whom have experience in the management of pain and other chronic medication needs often found in workers' compensation cases. Injured workers can rely on PMSI for answers to any need or question that arises. Ideal for long-term pharmaceutical benefits, PMSI’s Mail Order Pharmacy program adheres to rigorous standards to guarantee accuracy and efficiency.

Bringing pharmacy transactions in-network not only helps contain costs but also helps provide oversight to the injured worker’s prescribed medical therapy—critical to maximizing a PBM’s potential benefit. To capture out-of-network transactions, PMSI’s Network Penetration Strategies include a group of Specialty Networks and an out-of network Bill Review program. Our Specialty Networks include partnerships with industry-leading third-party billers, physician dispensers, occupational health clinics, mail order pharmacy providers, and compounding pharmacies. Use of Specialty Networks facilitates total management of all pharmacy transactions, allowing for clinical oversight and applying utilization controls to drive optimal health outcomes for injured workers. Through Pharmacy Outreach and Bill Review programs, PMSI helps clients reduce out-of-network spend 25% – 35%, as well as achieve complete control to manage an injured worker’s medication utilization.

Service Excellence

PharmaComplete is supported through our Pharmacy Center of Excellence, which applies best practices to ensure compliance, supports efficient claims management, provides knowledgeable support and delivers quality programs—all focused to deliver the highest degree of service excellence. PMSI achieves this through:

• State-of-the-art Call Center available 24/7, staffed with registered pharmacists and certified technicians to assist claim professionals and injured workers
• Best-in-class account management, network management, reporting and implementation, delivered by highly tenured staff focused solely on workers’ compensation
• Dedicated and experienced Government Affairs and State Reporting teams, addressing state-specific issues and actively participating in industry forums to help clients remain compliant
• Technology-enabled claim management and reporting systems, providing reliable decision support tools
• Online tools for instant information for injured workers, employers, pharmacists and physicians: Pharmacy Center and Locator, MyWorkComp mobile app, Ask the Pharmacist, Pain Management Resource Center, MyClaimsKit.com, medication references, mail order resources and state regulations

Through PMSI’s MedAssess program—one of the most advanced clinical programs in the industry—PMSI helps ensure safe dispensing, and manages utilization and appropriateness, while containing the unit cost of drugs. Based on clinically sound, evidence-based guidelines, the proprietary MedAssess program is supported by a data-driven analytical engine, MedAssess Risk IS™. Through reports generated by Risk IS, clients gain valuable visibility into their pharmacy claims, facilitating better overall pharmacy case management.