Drug VALUE Solutions

Recent changes to the review of drug cost allocations by the Centers for Medicare and Medicaid Services (CMS) has raised settlement costs higher than ever before. In our continuing effort to contain costs, PMSI uses an evidence-based, proprietary algorithm for calculating and reducing drug allocations. This algorithm is based on PMSI's experience as the only company in the industry with a long history of pharmacy expertise and knowledge, and it is the foundation for the development of the most technologically advanced solutions to manage and contain drug allocation costs.

Drug VALUE Tool

Employing the most up-to-date data specific to the workers' compensation population from PMSI’s Annual Drug Trends Report, PMSI's Drug VALUE Tool  uses a proprietary algorithm to calculate projected savings for a claim to determine if a comprehensive Drug VALUE Review (DVR) should be performed. The Drug VALUE Tool is the first mobile computing application for the workers’ compensation industry. A real-time solution, it is available anytime, anywhere—accessed from an iPhone or iTouch device, a desktop link or directly online to instantly calculate average costs of the current drug treatment projected over the life expectancy. 

PMSI’s Drug VALUE Tool will allow you to:

• Estimate the pharmacy portion of your Medicare Set-Aside (MSA) allocation
• Identify opportunities to lower drug allocations
• Contain prescription allocation costs
• Reduce overall settlement costs
• Estimate future pharmacy claims reserves for all claims

Drug VALUE Review

Our proprietary Drug VALUE Review (DVR) will help mitigate MSA allocations and lead to lower settlement costs. PMSI’s DVR is a comprehensive assessment and drug cost allocation forecast based on published clinical research on all drugs common to workers’ compensation and liability claims. PMSI uses a technically intricate algorithm to assess several key factors that drive up medical costs due to prescribed drugs. The DVR is recommended for all claims that contain high-cost drugs as identified through the Drug VALUE Tool, PMSI’s proprietary drug assessment application. The DVR includes a detailed analysis of each drug and its impact on the future costs of prescriptions specific to the claim. The cost savings realized through the use of the DVR are unequaled in the industry. With PMSI’s DVR, you can assess current medication utilization, confirm medications are appropriate for the primary injury, and evaluate appropriate medication utilization over the projected lifetime of the injured worker. DVR is another innovative service from PMSI—our proven solutions are based on over 33 years of experience as a leader in workers’ compensation pharmacy cost containment. With PMSI as your partner, you can settle more cases quickly, cost effectively and with confidence.