Yes, I said “drugs” instead of medications and for sale they are. To make things worse drug companies are marketing experts and spend billions on their sales campaigns.
You may think the doctor has put good time into researching the prescription they just wrote, but too often the provider is just pushing the last drug reps request or sample. Patients often ask for prescriptions in an attempt to shift cost from their personal medical insurance or own pocket.
“The results of a Workers’ Compensation Research Institute study suggest that a closed pharmacy formulary similar to the one implemented in Texas could reduce the prevalence and costs of prescription drugs in other states. The WCRI study cited 2013 numbers from the Texas Department of Insurance report, which showed that new claims with non-formulary drugs that required preauthorization decreased by 67% from 2010 to 2011. Prescriptions written for non-formulary drugs decreased by about 70% for those new claims, and non-formulary drugs’ share of the total prescription drug costs for new claims decreased by more than 80%. Drug prescriptions included in the formulary fell by 4%, and total opioid prescriptions fell by 10%.”
By enforcing your State’s regulations on use of formulary drugs the carrier has opportunities to manage and reduce the cost of medication. Medication reconciliation has become a nationwide task and presents another opportunity to fine tune the medication regimen with a provider. A case manager can address medications by updating a physician on your State’s formulary drugs list or reviewing medication guidelines with the prescriber. In today’s market keeping a close eye on prescriptions and taking advantage of opportunities to manage drug cost is a vital part of controlling your bottom line.
Reference: Work Comp Research Institute – Impact of a Texas-Like Formulary in Other States
Vennela Thumula, and Te-Chun Liu
Vennela Thumula, and Te-Chun Liu