Workers' Compensation Clinical Services
The Clinical Services department employs a staff of highly credentialed full-time pharmacists and nurses that perform many levels of service to our clients dependent upon their needs. They work with the client to ensure the medications in network are audited for appropriateness. The exchange between pharmacist and claims professional, both general and injured party-specific is vital to realize the maximum potential of the payor-PBM relationship. According to the National Council on Compensation Insurance, future prescription drug spending may constitute as much as 18% of workers' compensation healthcare spending. Having pharmacists with relevant experience readily available to help guide the claims professional is an essential piece in achieving efficient utilization of drugs.
Our Clinical Services team performs the following functions and reports:
- Ask-a-Pharmacist and Ask a PMI Nurse
- A convenient resource for clients to obtain quick information from a clinical pharmacist or nurse regarding medication use in relation to an injured party's treatment
- Drug Utilization Evaluation (DUE)/Drug Utilization Review (DUR):
- Brief review of the injured party’s medication regimen
- Evaluates appropriateness of drug therapy based on current prescription records
- Injured party is receiving seven or less medications AND five or less years has lapsed since the injury
- Intervention RX™
- Offers an option of several different levels of analysis completed by a pharmacist or a physician
- Assistance to the claims professional satisfying state-based regulations for therapeutic modifications as well as streamlining and optimizing care
- An in-depth clinical review of an injured party’s prescription usage
- Drug by drug analysis of medication-related clinical concerns
- An option that includes a physician consultation with the treating practitioner
- Cost Projections for Medicare Set-Asides
Medicare requires prescription drug cost projections as a component of all WCMSAs. Progressive Medical's expert pharmacists can provide valuable information and potentially save you settlement dollars.
Contact our Clinical Services team via e-mail at ask-a-pharmacist@progressive-medical.com or call 866.742.7676 (866.PHARM-PMI)