Unique PBM delivers cost containment and outcomes management

Pharmacy Benefit Management (PBM) for workers’ compensation is one of PMSI’s core competencies—this dedicated focus allows us to consistently provide the best solutions customizable to our clients’ needs for workers’ compensation pharmacy challenges. With PMSI, you have a clinically based, industry-specific program integrating cost containment with outcomes management from the point of injury.

PMSI’s owned network of over 60,000 participating retail pharmacies nationwide means we have direct relationships and contracts with senior retail chain executives and corporate offices. This provides the opportunity for client-specific program customization. Our Retail Pharmacy program, known as Tmesys™, is supported by over 100 customer-care professionals 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 maximum control, quality care and up to a 25% cost savings. The program provides a high level of personalized service and is staffed by a full complement of registered pharmacists and supporting pharmacy technicians, with particular experience in the management of pain and other chronic medication needs often found in workers’ compensation cases. Adjudicated through our PBM platform, the Mail Order Pharmacy is ideal for long-term pharmaceutical benefits and adheres to rigorous standards established to guarantee the accuracy and efficiency of our systems.

The value of a pharmacy program is intrinsically linked to the ability of a service provider to minimize out-of-network spend. To capture the full potential value of our Pharmacy programs for our clients, PMSI has introduced comprehensive conversion solutions to strengthen network penetration throughout the life of the injured worker’s claim. These innovations include aggressive compliance programs, the direct re-indexing of claims, third-party biller arrangements, and the adjudication of prescriptions dispensed in clinic and mail order pharmacy settings.

Achieving savings through a pharmacy program requires addressing the real cost drivers in workers’ compensation: drug utilization, prescriber activity, and medication mix. PMSI’s MedAssess program delivers three levels of care: Utilization Control, Targeted Intervention, and Care Management, with the goal of managing overall product and service utilization. With this clinical oversight and reporting, MedAssess provides clients valuable visibility into their pharmacy claims and facilitates better overall pharmacy case management.