Retail Network (Tmesys®)

PMSI’s Retail Pharmacy program, Tmesys, addresses the complete pharmacy management lifecycle, from first fill to final bill. The program offers convenience for injured individuals as well as claims professionals by providing fast, accurate prescription dispensing with no out-of-pocket expense on approved medications. The density and success of our network—with over 60,000 participating retail pharmacies nationwide—ensures injured individual access to quality pharmacy care from trusted and familiar pharmacies close to home or work.

Point-of-sale analysis advances program penetration

Instantly, at the point of sale, prescription claims are analyzed before medications are dispensed and before the payor is charged. In seconds, PMSI reviews each transaction against a series of over 100 prospective drug utilization review (DUR) edits and a workers’ compensation-specific formulary to safeguard injured workers, while spotting unnecessary or non-compensable prescriptions.

The system advances program penetration, achieving a standard of 70% to 80%—among the highest in the nation. Our all-points strategy centers on managing the channel, as well as the therapy, to ensure that eligible prescription claims are processed online where clients benefit from the full measure of the system’s checks and balances.

PMSI’s comprehensive programs drive utilization and compliance to capture prescriptions at the earliest opportunity—starting at the first fill, where PMSI guarantees payment on a 10-day supply of approved medications at the contracted rate and at no risk to the payor should the claim later be denied or inadvertently never filed.