Six Key Concepts in Pharmacy Benefit Management
The workers' compensation industry can be complex, from keeping up with regulatory changes to understanding the roles and responsibilities of various key stakeholders. Whether you are just starting out in the industry or looking to refresh your knowledge, here are six key concepts to understand about Pharmacy Benefit Management in the workers' compensation industry.
When are Specialty Drugs, Biologics, and Biosimilars Used in Workers’ Compensation?
3 MIN READ
For workers’ compensation, specialty drugs are prescribed to treat conditions either directly or indirectly related to workplace injuries or illnesses. Directly related conditions, such as HIV and hepatitis, might occur when individuals are exposed to contaminated material (i.e. those working in healthcare or emergency service settings). Indirectly related conditions, such as inflammatory arthritis, are common, and the subsequent work disability and/or potential of being linked to this group of illnesses is significant. Other indirectly related conditions that could be compensable in workers’ compensation are those aggravated by a workplace injury, including multiple sclerosis. The impact specialty drugs will have on workers’ compensation claims will depend largely on the demographics of the insured population.
The Difference Between Specialty Drugs, Biologics, and Biosimilars
3 MIN READ
In the world of workers’ comp pharmacy benefit management, understanding generics vs. brand name drugs, narcotics, muscle relaxants, and compounds now seems relatively simple as compared with the latest pharmacy terminology: specialty drugs, biologics, and biosimilars. These terms are making the headlines with increased frequency, and while some think they are interchangeable, there truly are distinctions between them.
Topical Trend Differences: Understanding Drug Mix
1 MIN READ
Topical medication cost and utilization continue to decrease in the managed population. However, in the unmanaged space we continue to see year-over-year increases in both cost and utilization. Understanding the differences in the types of topical medications dominating each space can help us to target pharmaceutical management strategies that weed out price opportunists and ensure the most appropriate care.
Before You Choose a PBM, do the Math
1 MIN READ
Cost is black & white Price alone isn’t. Your PBM must also control utilization or you’ll be seeing red.
Off Patent Medications & Drug Patent Expiration: Quarterly Drug Update
3 MIN READ
Managing pharmaceutical decisions in a claim can greatly impact the outcome of that claim, from recovery time to costs. Therefore, close monitoring of pharmacy changes and compliance updates is vital. In our previous quarterly update, we took a closer look at the utilization of generic drugs and 'me-too' medications.
Implications of Epidiolex FDA Approval on Workers' Compensation
4 MIN READ
In June 2018, the Federal Drug Administration (FDA) approved Epidiolex, the first plant-derived cannabinoid medicine in the United States. With several states already moving toward legalization of medical marijuana, this is a major step for the federal government.