3 Traits to Look For in Your Pharmacy Management Solution Partner

With the decline in opioid prescriptions, innovative strategies are essential to manage rising topical medication costs without compromising quality care.

A single workers’ compensation claim has several moving parts: scheduling appointments, return-to-work strategies, keeping all stakeholders informed and more.

Pharmacy management is another piece of the comp puzzle that must be addressed. Brand drugs and other prescription practices used in workers’ compensation can quickly drive claims costs if they’re not managed effectively, and minimizing patient risk and reducing pharmacy spend should go hand in hand.

“Injured employees waiting at the pharmacy for their medications can become a significant pain point,” said Sarah Scott, Vice President of Network Services for CorVel.

“Likewise, not having a clear view of the best pharmacy management solution strategy can slow down the process and become costly,” both in terms of the actual price tag and in terms of patient recovery.

Finding a pharmacy management solution does not need to feel like an added chore. According to Scott, there are three key elements that make up a good pharmacy solutions partner: transparency, cost efficiency and customization.

HERE’S A DEEPER LOOK AT THESE THREE TRAITS, WHY THEY ARE IMPORTANT WHEN IT COMES TO PHARMACY MANAGEMENT IN WORKERS’ COMP, AND THE ADDED BENEFITS OF FINDING A SOLUTION-DRIVEN PHARMACY MANAGEMENT PARTNER.

1.) Transparency and Service Excellence

Good communication is always appreciated, no matter the discipline or industry.

In workers’ compensation — and specifically pharmacy management — effective communication is demonstrated through transparency in costs, performance and clinical engagement.

CorVel emphasizes full visibility into medication costs, offering fair pricing strategies that align with or fall below jurisdictional fee schedules where applicable. We avoid promoting or taking rebate credits on brand medications, ensuring clients can trust that pricing reflects genuine value without hidden incentives.

This is done in an effort to eliminate unwanted surprises throughout the process. It’s also done to show that pharmacy management solutions can be tailored specifically to the needs of the workers’ compensation space.

Workers’ comp can be a complex industry, and any workers’ compensation partner must have the skills to navigate the space effectively. Transparency in pricing and performance is a great start, but true mastery comes with the people supporting these efforts. That’s why good communication in customer service must be weighted equally to transparency.

To meet the diverse needs of patients throughout their pharmacy journey, CorVel has developed a highly qualified team. All customer service representatives and management staff within the pharmacy division are certified pharmacy technicians, ensuring they possess the technical expertise required to address industry-specific challenges effectively.

In addition, the team includes PharmDs and pharmacy nurses, fostering a patient-centered clinical approach to care. This ensures safe, appropriate, and cost-effective medication management while maintaining a strong focus on effective communication with clinicians and other stakeholders.

By combining transparency in operations with a clinically knowledgeable and service-oriented team, CorVel delivers tailored solutions that drive better outcomes in the workers’ compensation space.

2.) Pharmacy Spend Reduction and Efficiency

Being upfront and transparent goes a long way in pharmacy management and patient recovery. The next step in the process is having a partner who actively finds ways to reduce costs where appropriate.

CorVel approaches pharmacy spend reduction in several key ways: through strategies like maximum network penetration, custom formulary management, generic substitution, and aggressive utilization management.

Maximum network penetration refers to optimizing the volume of prescriptions processed through a pharmacy network. This approach enables proactive control and management of prescriptions, ensuring that all aspects of medication use are effectively monitored and aligned with organizational goals.

Formulary customization can also be implemented at a granular level for individual claims. This approach allows the formulary to be tailored to meet the unique requirements of both the client and specific claims, ensuring precise and effective medication management. CorVel does this to ensure prescriptions are appropriate and safe for the injury in question while also keeping a finger on the pulse of out-of-network prescriptions, which can be redirected back in-network to better manage their cost.

Custom formulary management involves offering tailored solutions at various levels to meet specific client needs. At the client level, this includes the ability to create a customized formulary where the client determines which medications are approved for use and which require prior authorization. This flexibility ensures that formulary management aligns closely with organizational priorities and policies.

These efforts further reduce time to fill because they enable the client to decide which specific medications are paid for upfront. Another key savings approach is that the formulary itself is universally generic, meaning any brand-name medications must receive prior authorization before being dispensed.

Utilization management ensures that the medications and other treatments administered are appropriate for the individual claim. This is especially important in the management of opioids, high-cost prescription topicals, or specialty medications.

As a team of healthcare professionals, the primary responsibility is to collaborate in identifying the treatments an individual needs to achieve a full recovery. Staying ahead of emerging and newly developed medications is a continuous challenge. However, CorVel prioritizes staying informed about these advancements to ensure the highest level of service for clients and individuals involved in each claim.

3.) Customization and Integration

The final trait of a good pharmacy management solution partner is an ability to customize its services to match the needs of its clients.

The CorVel team has worked to tailor its solutions to meet the unique needs of each client, as seen in its ability to allow the client to decide which drugs can be paid upfront and which require prior authorization.

Taking this a step further, integration is a key component of the solution. CorVel analyzes the various elements of a prescription, such as out-of-network spending, state formularies, and fee schedules, and integrates them into its workflow. This integration streamlines processes and delivers efficient solutions to clients.

CorVel offers a variety of integrations, with one of the most impactful being the ability for clients to access the system directly and view key medical components of a claim to assist in the determination of prior authorization. This process provides full visibility into medical spending and access to information on previously dispensed medications from prescribers.

Bringing Pharmacy Management Solutions Under One Roof

With over 35 years of experience in the workers’ compensation space, CorVel not only demonstrates the key traits of a pharmacy management solutions partner — its team lives by them.

CorVel’s goal is to provide tailored solutions that address the specific needs and challenges faced by clients. The approach is centered around the unique nature of each case, taking into account the injury, task, and employment context of the individual involved in the claim. This targeted focus creates natural guardrails that ensure the delivery of the most appropriate and effective care for each individual.

CorVel has invested significant time and effort into acquiring the resources necessary to offer clients a comprehensive formulary focused on the medications needed for recovery. The company has worked to make this process as transparent as possible and offers 24/7 access to customer service should any questions arise.

CorVel’s pharmacy management solution goes beyond cost reduction. We actively provide a transparent, efficient, and client-centric approach to pharmacy management, placing the needs of clients and the care of the injured employee at the center of its operations.