To help employers control the escalating
costs of prescriptions for employees
out on workers' compensation, CIGNA announced
the new Workers' Compensation Pharmacy
Benefit Management (PBM) Solution. This
integrated program is designed to reduce
workers' compensation pharmaceutical
costs by as much as 75 percent.
"By pairing CIGNA Pharmacy Management's
(CPM's) recognized low net cost and clinical
pharmacy expertise with Intracorp's industry-leading
capabilities in workers' compensation
management, this new program is designed
to deliver savings to the employer and
help minimize dangerous drug interactions," said
Fred Scardellette, vice president of
product, marketing and fee management
operations for Intracorp. "Savings
will be achieved through discounts, preventing
duplicate prescriptions, an electronic
payment system, use of a formulary, and
controlled utilization to eliminate fraud
and abuse," he continued.
According to the National Council on
Compensation Insurance (NCCI), workers'
compensation carriers spend over $3.5
billion on prescription medications annually.
Pharmacy costs represent 10 to 20 percent
of total workers' compensation medical
bills and the amount is increasing at
a rate of 10 to 17 percent annually,
according to Health Strategy Associates.
In addition, when Archestral, a health
care data analysis firm, audited two
million paid workers' compensation prescription
claims last year, it found that 20 percent
of payments included at least one error,
such as incorrect pricing or a drug that
wasn't indicated for the particular diagnosis.
"For the past ten years, I've worked
both sides of the house -- group health
and workers' compensation. In my evaluation,
it made no sense that a prescription
that costs $35 under group health may
cost $100 under workers' compensation," said
Charlotte Perkins, chief human resources
officer at Performance Food Group, a
national food service distribution company
with more than 7,000 associates. "I
tried for years to get somebody in the
industry to look at the issue and work
with us to find a sensible solution.
CIGNA was the first company willing to
sit down and listen to what we had to
say."
Perkins implemented the CIGNA program
in July and has already seen an immediate
19 percent savings and 85 percent generic
utilization rate for her company. "That
doesn't take into consideration abuse
and fraud," notes Perkins. "Double-dipping
is a huge problem in workers' comp. We
also expect to realize additional savings
by using the formulary to steer employees
toward generics instead of brand name
drugs and by requiring mail order for
maintenance medications."
A second tier of savings comes from
Drug Utilization Review (DUR), a comprehensive,
systematic review of drug use patterns
and cost data, which can mitigate health
and safety risks and could more than
double fee schedule savings by further
reducing inappropriate drug use and fraud.
It provides maximum benefit when linked
to the group health system. This integrated
DUR, in which group health and workers'
compensation prescription claims are
housed within the same system, can flag
such potential problems as dangerous
drug interactions, early refills, duplicate
prescriptions, therapeutic duplication,
or misallocation of pharmacy payments
between group health and workers' compensation.
"We will be applying a fully integrated
pharmacy claims processing system to
the workers' compensation system for
the first time ever. Whether the employee
is obtaining prescription medication
through group health or workers' compensation,
the same ability to improve outcomes
and manage costs will apply," said
Thom Stambaugh, chief pharmacy officer
for CPM. The Workers' Compensation PBM
Solution will be administered by ScripNet,
a company that specializes in serving
the needs of injured workers and those
responsible for their care.
