Impact of Physician Dispensing on Work Comp Costs
Learn about the impact of physician dispensing on overall costs and exposure in work comp claims. Discover tips on managing pharmacy costs effectively. Explore price differences, mark-ups, and strategies to minimize expenses.
Impact of Physician Dispensing on Work Comp Costs
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Presentation Transcript
Physician Dispensing in Work Comp • Impact of the practice on overall costs and exposure • Tips on how to manage it
Pharmacy drives 10-20% of your unit cost as a percent of total medical. What percent of your total exposure relates to claims with prescription meds and IWs suffering from pain? Source: 2011 NCCI Issues Report
Physician Dispensing Price Difference: Tramadol • * Percent of mark-up measured against original manufacturers’ AWP.
What the studies say: Impact of Physician Dispensing on Total Claim Costs
Questions for the Audience • Where do we see “third party billing?” • Retail, Physician Dispensing, Everywhere! • Stone River (retail and physicians), Prescription Partners
Questions for the Audience • Where do we see “third party • Partners • What is the legal status of the third party biller? • Assignee • What are the obligations of an assignee? • Identical to the underlying provider
Questions for the Audience • Where do we see “third party • eywhertail and p • What are the obligations of an assignee? • Identical to the underlying provider
Assignees are ALREADY OBLIGATED! • PBM Contracts with underlying pharmacies • PPO Contracts with underlying prescribers • The Facts
Assignees are ALREADY OBLIGATED! • PBM Contracts with underlying pharmacies • PPO Contracts with underlying prescribers • Impact of contracts with assignees • Grant them rights and frees them from obligations • Disables Prospective Mgt/ Enables more retro • PBM re-sells transaction at a spread • Expedient? • Right thing to do? • The Facts
Apply underlying PPO discount • Can I? • Everywhere? • Yes you can! • Deny subsequent transactions based on PPO contractual obligations • Can I? • Everywhere? • PPO - Utilization Mgt or specific prohibition • Contractually yes, but leverage is the issue • Requires notice • Re • What you can do
Question for the Audience • What presents more risk in terms of your cost drivers? • Unit price? • Utilization? • The unknown?
Identify providers who dispense meds in office • Leverage bill review • Manage the data • Maximize provider selection tools • Include a physician dispensing indicator • Layer the order based on criteria • Preclude panel populating • Educate your PPO providers • Re You can make the unknown more known!
