A. What do these pharmacy companies do ?
ABRAMS LANDAU clients have utilized several Pharmacy Services companies. In many cases, they fill client’s prescriptions, provide “durable medical goods” (for example, canes, walkers, home care equipment), and deliver these things directly to the patient’s home, saving trips to the pharmacy, paperwork, out of pocket costs and uncertainties as to reimbursements.
B. Who administers these programs ?
C. How does it work ?
An injured worker with a compensable claim that has been approved for prescription medication, can be eligible for these companies’ services. The Pharmacy Service staff coordinates with the insurance carrier to verify what prescriptions have been approved, and ship them directly to injured worker’s door, with no out-of-pocket costs to them !
Where a claim is disputed, these Pharmacy Services staff work on behalf of the injured worker to continue filling the prescription. There is also a Prescriptions At Cost (PAC) Program for medications that have been denied or deemed not medically necessary by a Utilization Review. This program can result in considerable costs savings. Those costs could be reimbursable, depending on the outcome of the Hearing or review.
Post Settlement Prescription Plans are available for clients to provide medications after cases settle. The pharmacy service may work with the physician and attorney to help determine a sufficient settlement amount to cover prescription costs after a case settles. If the injured worker or their family are not part of a group health insurance or disability plan, this may make sense, and save dollars, after their case is settled with the Employer, their Workers Compensation Insurance Company or their Third Party Administrator (TPA).
D. How does it help the injured worker, the doctor and the lawyer ?
1. How the Pharmacy Service Helps the Patient:
a. They deliver medication to the patient when they receive their prescription.
b. They use UPS to deliver the medications to the patient’s door. Doing so eliminates trips to the pharmacy and makes medications easy to track so their staff can alert patients about delivery date and time.
c. They automatically send out refills before prescriptions run out.
d. They ensure that each delivered prescription comes with thorough drug information and contraindications. Experienced pharmacists are available for patient consultations at toll-free phone numbers.
2. How the Pharmacy Services Help the Physicians and their Staff:
a. These Pharmacy Services give back patient control to the prescribing physician. They fill the medications that the doctor feels are necessary for the patient, taking care of authorization and verification issues.
b. The pharmacy service makes it easy for the treating doctors to track the care of their patients.
c. Their pharmacists are available for consultation and assistance in emergent or difficult cases.
d. The Pharmacy Services staff deals with insurance and administrative duties, thereby allowing the authorized treating doctor and their staff to take care of their practice.
What’s in it for them ?
Clearly the Pharmacy Services are not doing this without compensation. They are paid by the insurance companies, TPAs, self-insured employers and/or state uninsured employers funds. Because they buy huge quantities of medicine and medical supplies, they can get prices far lower than I could get if I walked into my local drug store ! So, not only is the injured worker helped and the doctor’s office assisted, but the Pharmacy Service is paid for providing this service, but not by the doctor or patient !
If you a workers comp claimant with an open Award, and are not taking advantage of a Pharmacy Service, please contact us at once.