The new Wausau program contains three main components to reduce the employer’s overall cost for many of the pricier prescriptions given to injured workers on workers compensation, according to a news release.
One new component – an improved work flow – offers advice from a team of pharmacists, pharmacy technicians and registered nurses who assist Wausau’s claim staff with drug management plans. This is designed to provide information to help make informed decisions and push back if there is a better alternative that might include a drug substitution or conversion to generic drug or suggestions for medical management calls to the medical doctor. If additional expertise is needed, a system is in place to escalate the process to a medical case manager or to a team manager.
Another new component is a drug utilization program that contains a series of controls at several levels:
- Level 1 – the pharmacy level where business rules and formulary edits take place. This typically includes antibiotics, anti-inflammatory medications and pain medication within certain dosages and types.
- Level 2 – when a pharmacist, pharmacy technician or nurse interact with Wausau’s claims and managed care team, there are several business rules covering “red flags” for prescription management.
- Level 3 – a review of each claim file and the type of drugs to determine if the medication is related to the injury.
Wausau’s system also issue each injured employee a card and an assigned “billing identification number.” The employee is then directed to Wausau’s pharmacy group of 50,000 pharmacies and presents the card to a pharmacist, who identifies the injured employee as a Wausau customer.
More information is available at www.wausau.com .
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