By Silvia Sacalis, PharmD, VP of Clinical Services, Healthesystems
A prescription drug therapy is often one of the first medical transactions that occur on a workers’ compensation claim, creating an early touchpoint for the injured worker patient in the workers’ comp medical management process. Based on the latest NCCI data, prescription drugs represent approximately 7% of medical costs on a claim – and importantly, a small portion of claims drive the majority of these costs due to complexities that often include concerning drug regimens. Prescription drug management provides an early opportunity to proactively manage risk on a claim, and the training and expertise of pharmacists is central to the tools and programs that drive this management.
Given this, it’s very fitting that October marks American Pharmacists Month – and I welcome the opportunity to celebrate pharmacists for their important work this month.
In my current role, I have the privilege of leading a team of outstanding clinical pharmacists – some of whom work directly with clients on their programs as part of our multidisciplinary account support model, and others who work behind the scenes delivering the interventions that drive our clinical offerings and support our injured worker patients.
Here are just a few of the reasons the pharmacist is crucial to the successful management of pharmacotherapy in injured worker populations:
We know how medications work to help the injured worker patient – and when they present harm. Pharmacists receive extensive training that empowers them to help optimize treatment options, manage medication side effects, and identify the potential for patient harm, such as drug-drug and drug-disease interactions and therapeutic duplication. It is because of this finely tuned knowledge that physicians can view pharmacists as a complementary partner in patient management – especially in the injured worker population, where pain management brings into focus concerns such as controlled drug therapies and high-risk drug combinations. Regarding the relationship between physicians and pharmacists, the World Medical Association states that “collaboration between these professions is imperative, including with respect to the development of training and in terms of information sharing with one another and with patients.” I couldn’t agree more. As healthcare professionals collaboratively invested in the recovery and well-being of injured worker patients, the more we can open lines of communication, partnership, and knowledge-sharing, the better.
We are among the most trusted professions. Year after year, pharmacists rank highly in a Gallup poll designed to assess public perception of the honesty and ethics of various professions. And while we can likely attribute this in part to our expertise and specialized training, there is also a very human element to trust. Pharmacists, compared with other healthcare professionals, are in many ways more accessible. Patients don’t need to schedule an appointment to talk to a pharmacist. Retail pharmacists are a wealth of knowledge that is available and readily accessible at a community level. In the workers’ compensation PBM world, as clinical pharmacists the way we interact with our very specific community looks a bit different, but the tenets still hold true. Which leads me to my next point.
We are well-positioned to engage with key stakeholders in prescription drug therapy. Two of these critical stakeholders are the people prescribing drug therapies, and the people receiving them. As healthcare professionals, by nature, pharmacists are very patient-centric. This includes pharmacists at a PBM. While we may not stand behind a retail counter, injured worker patient advocacy is a part of our role. This may include one-on-one consultation with injured worker patients when there are opportunities identified for therapeutic optimization, adherence management, side effect management, and other drug regimen concerns – and this high-touch approach can be successful in moving the needle among injured worker patients exhibiting therapeutic risk. Of course, the prescriber truly holds the keys to the castle in terms of decision-making related to prescription drug therapy. Which is why prescriber outreach is another important aspect of our role.
Our human expertise can be operationalized. While high-touch intervention and outreach have dramatic impact in highly complex and costly cases, the magic in clinical expertise comes when it is baked into a program to have early and broad impact – helping to prevent added cost and complexity across populations before it even has a chance to show up. In a PBM, you’ll see the clinical pharmacist’s knowledge present in everything from strategic formularies to the application of the clinical rules, logic, risk criteria and workflow designs that help drive decision-making towards evidence-based prescribing.
We are unapologetic trend hounds. Pharmacy is a dynamic environment – it’s one of the reasons that makes its management so complex. Think about this: from 2013-2022, FDA’s Center for Drug Evaluation and Research (CDER) has averaged 43 novel drug approvals per year. Of course, only a portion of new drugs touch workers’ comp, but there is still plenty to watch. We’ve been seeing quite a shift in workers’ compensation prescription drug trends over the last several years as the industry continues to move away from opioids and towards more diffuse drug trends. I touched on a few of these trends at my recent presentation at the 2023 National Comp Conference, but overall we’re seeing a continued rise in specialty utilization and costs, physician-dispensed dermatologicals, infusibles and injectables, and some outliers such as novel migraine agents and “designer” NSAIDs that represent a small portion of prescriptions but come at a very high cost. While we as an industry are very fortunate to reap the benefits of dramatic reductions in opioid utilization – including improved injured worker patient safety and reduced associated costs – we as pharmacists are committed to remaining vigilant as we track trends both waning and emerging.
We are committed to continuous learning and knowledge-sharing. Many members of my team are engaged in the broader pharmacist community, including in leadership roles. And my organization and my team are committed to fostering the next generation of clinical pharmacists through an internship program with multiple state universities. Several members of my team have also been recognized by the workers’ compensation industry through awards such as IAIABC Next Gen and Comp Laude. While these are all wonderful achievements, I really want to celebrate what’s at the heart of the accolades: the desire to apply our passion for pharmacy and the empathy with which we seek to enrich the lives of those around us – whether an injured worker patient, our clients and partners, or a fellow pharmacist or healthcare provider.
About Silvia Sacalis
Silvia Sacalis, BS, PharmD, provides clinical leadership and strategic direction as Vice President of Clinical Services at Healthesystems. Her healthcare experience and clinical expertise span the PBM, retail pharmacy and managed care environments. Leveraging her technology background, clinical skills and management expertise, she helps develop and operationalize strategic clinical initiatives to help workers’ compensation insurance payers maximize the impact of a pharmacy benefit management program. Throughout her career, she has held various leadership roles in which she provided oversight of clinical services teams, the development of clinical programs, and integration of analytics technology coupled with clinical consultative support. Dr. Sacalis is a national thought leader and contributor to various industry presentations, publications and interviews.
Dr. Sacalis received her Bachelor of Science in Computer Science and Doctorate of Pharmacy degrees from the University of Illinois at Chicago.
Healthesystems is a specialty provider of innovative medical cost management solutions for the workers’ compensation industry. The company’s comprehensive product portfolio includes a leading pharmacy benefit management (PBM) program, expert clinical review services, and a revolutionary ancillary benefits management (ABM) solution for prospectively managing ancillary medical services such as durable medical equipment (DME), home health, physical medicine, transportation and translation services. By leveraging innovation, powerful technology, clinical expertise and enhanced workflow automation tools, Healthesystems provides clients with flexible programs that reduce the total cost of medical care while improving the quality of care for injured workers. To learn more about Healthesystems visit www.healthesystems.com.
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