The Fund Partners with Progressive Medical Inc. to Help Control Rising Pharmacy Costs in Workers Comp

by Herman Wilks

Whether it’s inventive television, radio, or print advertisements, drug manufacturers spend millions of dollars annually to promote the next best medication to hit the market. Even if it’s the tried and true medication we all knew as children or it’s the latest hard to pronounce medical miracle in a jar, there is no doubt that groundbreaking strides have been made in the drug market. All FDA approved medications are painstakingly researched and tested to ensure their safety and effectiveness. With promotion and research there are costs, which are continuously rising.

There was a time when a workers’ compensation (WC) file was comprised mostly of either medical costs or income benefits and medications represented a small percentage of each file. But the fact is medications are rapidly playing a much larger role in each claim file. In fact, the Fund pays an average of $4 million dollars in medications annually. This is due to a combination of the rising costs of medications, as well as higher utilization of medications. The Fund needed a partnership with a Pharmacy Benefit Manager (PBM) with a proven track record for balancing effective cost containment while allowing injured workers the medications needed to treat their work related injuries.

Recently, the Fund partnered with Progressive Medical Inc. (PMI), to provide pharmacy management services for all Fund members participating in the WC program. PMI has been in the WC business since 1986 and has a proven reputation as an industry leader. A WC pharmacy manager functions similarly to a group health prescription drug card program, but is geared towards medications associated with an injury. When employees are injured on the job, they are issued a drug card that allows them to fill medications at a participating retail pharmacy. For the injured worker, this provides ease in filling prescriptions. Behind the scenes PMI provides: 

• First Fill Program – This program puts temporary cards in the hands of administrative personnel and supervisors to give to workers when they are injured. This allows them to seek immediate medical attention and temporarily receive medications until the claim is reported and investigated by TASB.
• Effective Drug List or Formulary – When an injured worker presents a prescription to the pharmacy, it is electronically reviewed by PMI to ensure the medication is related to a WC incident and injury, and that it is not being filled too soon. PMI also reviews the drugs to determine if there is a negative interaction with another drug the injured worker may be currently using.
• Risk Assessment – PMI uses system edits, staff, and pharmacists to review the drug utilization patterns of every injured worker. PMI then alerts the adjuster if an injured worker is approaching the limits of his or her medication protocols. This allows the adjuster, with the help of medical professionals, to control over utilization of potentially addictive medications.
• Hard Savings – PMI offers discounts below the currently approved Division of Workers’ Compensation (DWC) Medical Fee Guidelines for medications filled using a WC pharmacy card at a participating pharmacy. This represents immediate savings for Fund members.

While the Fund has used a pharmacy benefit manager or the past 12 years, PMI’s pharmacy management philosophy was more compatible with the overall goal of the Fund to provide effective WC claims handling while controlling costs.  

Initial implementation meetings are well underway with a tentative “go live” date scheduled for June 16, 2008. Current Fund members who participate in the WC Program will receive special implementation information from PMI. Additionally, TASB staff members will also be communicating with Fund members to assist with implementing this new pharmacy solution. In the interim, we are happy to accept any questions or concerns you may have. Please call Herman Wilks at 800.482.7276 extension 7272, or Krista Fergason at extension 4155. 

Email: