A Pharmacy benefit management (PBM) company is a company that manages the pharmacy end of any benefits package. This includes various prescription medications and procedures. Although most health plans, including workers’ compensation, have a pharmacy Benefit Management company, some do not. Some of the most valuable aspects of Pharmacy Benefit Management happen when it facilitates prescription medications through workers’ compensation.
A Patient-Centered Approach
The top-rated PBM companies for workers’ compensation take a patient-centered approach to manage prescription benefits. They negotiate with drug companies and suppliers to achieve the best possible medications for their clients.
It also means that prescription benefit managers ensure vital medications are available to those they cover. In the case of workers’ compensation, patients receive the medications they need to recover from their injuries and return to a productive work life.
An Updated Formulary
The pharmaceutical industry is changing rapidly. New medications and improved treatments are constantly being tested and released onto the market. This release is sometimes not widely publicized. When workers’ compensation works with a prescription benefit manager, they receive continuously updated formularies that provide access to new treatments for patients.
Service as a Middleman
Sometimes a middleman is an unwanted concept, but not in this case. In this case, they serve as a middleman between pharmaceutical companies and insurers, such as workers’ compensation.
- They negotiate discounts and then pass the savings to the insurers, ultimately lowering rates.
- A management company keeps some of the savings and rebates in order to make money. This results in some complaints against pharmacy benefit managers but more benefit managers being transparent about their fees.
- They process prescriptions with special attention to high-value and continuing medications.
- They operate most mail-order pharmacies.
Since there can be hundreds of different medications for each illness, these middlemen take the time to sort through and find the best, most economical medications for insurers and their clients.
How PBM Works With Workers’ Compensation
How pharmacy benefit management starts working is when employers pay premiums to the workers’ compensation fund. Those premiums go toward paying for medical care and prescription medications.
In the case of prescription medications, a pharmacy benefit manager negotiates the price of prescriptions with either the wholesaler or a manufacturer depending on the medication.
Since PBMs work with wholesalers, they are able to procure the best medications for their customers. This is particularly true regarding specialty medications that might not otherwise be available.
Generics
Although the industry has fallen under some criticism over its definitions of brand and generic medications, many of them are now standardizing what is and is not generic. This helps a wider range of people gain access to some previously expensive and unobtainable medications.
Their definition of generics can go either way. It can either be beneficial to the company employing the PBM or detrimental. This is why it is important to read a PBMs contract thoroughly.
Specialty Pharmacy Access
One of the more important things that pharmacy benefit management accomplishes is better access to specialty pharmacies and medications. A few of the more notable instances of this are:
- Cancer medications
- Rheumatoid arthritis medications
- Advanced treatments for mental illnesses
- Expensive and trial cancer medications
Despite the controversy surrounding pharmacy benefit management, it has proven extremely useful for many patients. The improvements made to access to different drug therapies have saved thousands of lives and granted access to a better quality of life for many.
Criticisms of The Pharmacy Benefit Industry
The main criticism of the pharmacy benefits industry is that they take some of the rebates from medications as profits. Companies are currently working to resolve this issue by becoming more transparent with their clients. This transparency should stop a PBM from taking advantage by stating exactly what they are charging for their services and where that money comes from.
In most cases, pharmacy benefit management for workers’ compensation makes medications more affordable and grants better access to lifesaving treatments. Although each benefit program is a bit different, most successfully negotiate lower costs for both employers and their workers.
