Wayne, PA – Genex Services recently announced the launch of Medication Safety 2.0, a customized and integrated approach to prescription drug management in workers’ compensation. An enhancement to Genex’s current PBM management program, Medication Safety 2.0 includes oversight and coordination for all pharmacy services, medication alerts, medication safety programs, integrated pharmacy telephonic case management, field case management, as well as comprehensive pharmacy, bill, and utilization review.
“It is a constant struggle for carriers and employers to find ways to better manage pharmacy utilization, in work comp settings,” said Ron Skrocki, vice president of product management and development for Genex Services, one of the nation’s largest providers of workers’ compensation managed care services. “The problem is there are too many silos in pharmacy management. We are missing opportunities for greater transparency, oversight and coordination that could lead to better outcomes.”
Obstacles to strengthening integration in prescription drug management include lack of communication among PBM and bill-review services; clinicians who aren’t current on utilization issues; and lack of strong and direct outreach to providers who prescribe outside of guidelines. In addition, customers are frustrated with a one-size-fits-all approach to pharmacy benefits, Skrocki said. “Increasingly, our customers are asking us to work with their PBM to design a network that meets their needs in a program designed to help their injured workers and promote savings and best outcomes.”
Genex announced the new generation of its medication safety program after conducting several pilot programs with large carriers and employers. One of the key components of Medication Safety 2.0 is availability of one-on-one counseling to providers prescribing outside of guidelines. After analyzing data, instead of simply making a phone call or sending a letter, a field case manager meets with the prescriber to review clinically supported prescribing guidelines.
Over the course of a year, one large carrier in the Northeast realized a 10 percent reduction in claims with pharmacy prescriptions by using the proactive early intervention model and an integrated medication safety program designed to eliminate waste and abuse.
This carrier also experienced a 30 percent increase in average pharmacy savings, realizing a substantial decline in annual pharmacy spend at a time when many carriers and payers faced year-over-year increases. The results occurred through ongoing monitoring and evaluation using dashboards, analytics, and claims data-driven stewardships to find opportunities for fine-tuning and incremental improvements within their nurse case management and claims practice.
Skrocki stressed that Genex is not a PBM. “We don’t negotiate prices with pharmacies and we don’t process the pharmacy claim,” he said. “Our focus is on medication safety, utilization review from trained nurses and physicians, adherence to guidelines and optimal network utilization. As with our case management programs, Medication Safety 2.0 is about the added value that comes from integrating the functions of a comprehensive pharmacy program.”
Source: Genex Services
Genex Services is a WorkCompWire Ad Partner.
This is not a paid placement.