Today’s issue of WorkCompRecap features the release of results from an interesting review of compound pharmacy prescriptions conducted by Effective Health Systems. The study addressed medical bills submitted to California workers’ comp claims offices in the last quarter of 2012 that came from out-of-network pharmacy providers and had not undergone a prospective UR.
According to EHS, of the 8,012 prescriptions worth about $4 million, 97% were denied based on a retrospective pharmacy review for medical necessity. The review involved prescriptions from 478 physicians and 190 pharmaceutical providers, of which only 41 providers were responsible for 50% of the requests and 31 pharmacy providers fulfilled 80% of the prescriptions, with one pharmacy accounting for 25% of all the bills.
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