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Workers' Comp

Integrated PBM Results in Double-Digit Savings

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Problem

A large national employer (115K employees) implemented ScriptAdvisor. A comprehensive analysis of their program revealed an opportunity for increased pharmacy savings through better clinical controls and visibility into all pharmacy claims.

 

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Solution

ScriptAdvisor’s integration with the Claims Examiner Portal (CEP) simplified end-user workflows by providing a unified view of the claim and making it seamless for users to move between pharmacy and bill review tasks. The increased visibility combined with the ScriptAdvisor clinical roundtable process on claims older than 3 years resulted in 100% clinical oversight.

 

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Outcome

The integrated program has resulted in a consistent and controlled program delivering better outcomes. The clinical oversight has decreased the amount of pharmacy spend on older claims from 86% to 77% in a 12-month period.

 

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29% Decrease in overall in Pharmacy Savings

 

9%-point decrease in pharmacy spend on claims older than 3 years
 

 

Having the bill review and the ScriptAdvisor programs integrated gives enormous ease of use.

VP Claim Operations, Regional Workers' Comp Carrier

 

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