HealthSmartRx Solutions Workers’ Compensation Pharmacy Benefit Management (HSRx WC PBM) offers additional strategies that help our customers further reduce pharmacy expenditures by providing injured employees convenient access to pharmacies in urban, suburban, and rural settings, as well as the clinical oversight necessary to assist in supporting a consultative pharmacy benefit design and implementation, including network and administrative and claims processing services, tailored educational support, standard, ad hoc and state reporting, as well as high quality customer service, utilization management strategies, and stringent security and quality management protocols in compliance with all state and jurisdictional requirements and regulations.

HSRx WC PBM Program includes:

• Largest workers’ compensation pharmacy network of more than 67,000 pharmacies, providing convenient access to pharmacies for injured workers nationwide
• Comprehensive First Fill services and strategies to maximize program penetration
• Automatically embedded Official Disability Guidelines (ODG) in our standard workers’ compensation formulary to help ensure that injured workers receive the safest and most appropriate treatment
• Management of Drug Utilization at point of sale through customizable formularies
• Ease of use with reduction/automation of workflow for adjusters, as well as online and real-time adjudication to streamline the decision processes
• Reliable pharmacy processing system with embedded security measures to avoid potential misuse and abuse
• Qualified staff, including direct access to in-house pharmacists for consultation and support
• Leading compound and repackaged drug management solutions to further reduce pharmacy spend
• Early intervention to avoid long-term, high-risk, high-cost claims
• Risk Scoring that may lead to the recommendation of drug urinalysis screening, medication reviews, peer-to-peer interventions, and/or pharmaceutical peer reviews by authorized providers to ensure appropriate care
• Reporting and analytics to further predict high risk injured workers and reduce increasing prescription