Downers Grove, IL – Coventry recently announced the launch of RxRN, a team of specially trained and return-to-work focused case managers who target claims at risk due to emerging and complex pharmacy utilization. The RxRNs collaborate with the PBM to manage all aspects of the claim – from first alert to last fill.
The RxRN extends the reach of pharmacy benefit management (PBM) programs by combining it with the knowledge, care, and one-on-one delivery model found in case management. The RxRN’s goal is to:
- Ensure engagement, safety and education with the injured worker
- Confirm pharmacy utilization is medically appropriate and supports a timely recovery
- Enable timely medical stability and return-to-work
- Consult with case managers when complex pharmacy issues are identified on open claims
- Provide consultations to adjusters on pharmacy questions and issues
- Collaborate with the PBM team to manage the total claim
- Review monthly customer PBM trend reports
- Negotiate MSA reductions
RxRN nurses work closely with the injured worker and the treating providers conducting ongoing outreach to review medications, align care plans with nationally recognized guidelines, and ensure timelines for discontinuation or weaning of narcotics. By engaging the provider the RxRN addresses the medical necessity of compounds, topicals, and other specialty drugs. The RxRN also monitors adherence to brand to generic conversion and performs ongoing follow-up with the injured worker to ensure compliance.
“Most employers and payors utilize PBMs which offer an excellent line of defense in managing ever increasing pharmacy costs. But PBMs, by design, only manage the pharmacy related aspects of a claim,” said Tammy Bradly, vice president of clinical product development. “With RxRN you can extend the reach of the PBM by combining it with the clinical expertise, care and trust provided by case management directly with the injured worker.”
And the early results speak for themselves. In a recent pilot program RxRN, working in conjunction with our PBM, delivered a 3.6% reduction in pharmacy cost and a 7.7% reduction in Morphine Equivalent Dose (MED) in year one and a 14% reduction in pharmacy cost and a 15.7% reduction in MED by year two. While program results will vary, we are very pleased with these early returns. The pilot also demonstrated a reduction in Medicare Set Aside (MSA) pharmacy exposure, shorter narcotic durations and improved patient safety, which reduced the likelihood of drug dependence, abuse and addiction.
Coventry WCS is a WorkCompWire ad partner.
This is not a paid placement.