Pharmacy Benefits Management (PBM) is rich in resources to help protect employers against inappropriate prescription use.

PBMs use:

• Evidence-based drug guidelines.
• Access to physicians representing multiple specialties to consult, review, and discuss prescribing practices with treating physicians.
• Prior authorization of all non-formulary drugs.
• Comprehensive pharmacy reviews when complex medication regimens may be questioned.
• Pharmaceutical analytics flagging possible misuse and abuse.
• Constantly updated drug formulary.

When initially reviewing your program, the program of your TPA or insurance carriers, ask these questions:

What percentage of your medical costs is related to pharmacy benefits? Ask for a current results report. Determine if you are in a "mandatory" state where substitution of generics is required. If not, ask the PBM how substitution is monitored. Do a full evaluation of the program currently in place, if there is one.

Before choosing a vendor, do your homework and compare several services. These services are easiest to integrate if they are aligned with the company handling your claims, but also consider programs that are unbundled if your claims administrator allows you to use services other than their own.

Most work-related deaths involve sudden accidents, where the person dies instantly. However, when the employee is severely injured yet survives for days/weeks/months, the medical expenses can be astronomical.

Lumbar strains cost thousands a year and lost productivity. Everyone brings different risk exposures to the table, so you have to look within your own shop and see where to try and reduce the risk.

Be the eyes and ears! Only the employee knows who, what, where, when, why, and how the injury occurred.  So as an adjuster or employer, what can you do?

Any claim can spiral out of control at any time, prompting the need for surveillance, vocational evaluations, job placements, several IME appointments, witness statements, and much more.

The #1 selling cost containment book for workers compensation is our 2012 Workers Compensation Management Program: Reduce Costs 20-50% manual. This 181-page guidebook helps assess company or clients' workers comp programs, design program materials, roll out a program to the organization, and monitor and manage the program once implemented. SPECIAL BUY ONE GET ONE FREE ENDS JULY 5!

Broadspire began its partnership with the SOS Children's Village as a part of Crawford's Global Day of Service in 2009. Since then, Broadspire has helped with several fundraisers and volunteer opportunities.

Don't gamble when it comes to Medicare/Medicaid Compliance!  

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