Pharmacy Benefit Management

pbm-lgWellComp has chosen Progressive Medical as our Pharmacy Benefit Management partner. Their national network of pharmacies and First Fill option ensure that injured workers have fast, easy access to the right medication so their recovery is not delayed. Built in cost saving discounts and other cost control measures helps clients realize significant savings and reduce their workers’ compensation pharmacy costs.


Over the years, Progressive Medical’s Total Pharmacy Management (TPM) program has remained on the cutting edge of service. By listening to the needs of claims professionals and injured parties, Progressive Medical has created and implemented custom processes to address many different pharmacy scenarios.


FIRST FILL®

When an injured party needs medication quickly, the First Fill option provides prompt access to Progressive Medical’s nationwide network of pharmacies allowing you to authorize only the “first fill” of the prescription immediately, without waiting for an approval.

Progressive Medical’s First Fill option provides many benefits including:

  • Immediate authorization
  • No third party biller inquiries
  • Payor-specific medication options
  • Same day expiration at midnight
  • Progressive Medical accepts compensability
  • Cost savings captured on the first prescription
  • No phone calls from the pharmacy


INSTANT ACTIVATION™

Progressive Medical created the Instant Activation program with claims professionals in mind. With this solution, injured parties receive quick prescription fulfillment with no out-of-pocket charges. You will love the ease of our Instant Activation program.

Program benefits:

  • Substantial time saver for claims professionals
  • Fast fulfillment with no out-of-pocket charges to the injured party
  • Authorization open at the claims professional’s discretion
  • Payor-specific medication options
  • One-time authorization, ending at midnight
  • Invoices are sent from one source, Progressive Medical



HOME DELIVERY: SCRIPT-WISE

Progressive Medical’s Home Delivery program enables the injured party to receive medications in a timely manner direct to their home. This program works especially well for injured parties that are unable to leave their home or for injured parties that will be on long-term medications.

Benefits of this program for both the injured party and the claims professional are as follows:

  • No medication shipped without authorization
  • No out-of-pocket expense to the injured party
  • Toll-free, refill line is open 24-hours
  • Online adjudication
  • Up to 90-day supply allowed
  • Dedicated Home Delivery Client Services Specialists


RETAIL DRUG CARD

The Retail Drug Card allows an injured party to obtain prescription medication at pharmacies nationwide on our program; thus, compliance is improved. Our Retail Drug Card program can be customized to fit your needs. 

Many of the other benefits of this program include:

  • Easier monitoring of the injured party’s medication usage
  • Cost containment reports available
  • Online pharmacy drug utilization review edits
  • Drug utilization review reporting on pharmacy expenditures
  • Customized medication plans
  • Dedicated Retail Drug Card Client Services Specialists
  • Extensive customer service training and certification


MEDICATION PLANS

Clinical pharmacists develop Medication Plans that allow medications to be based upon the body part and the nature of the injury rather than being based solely on business rules.

The process for developing a specific medication plan is as follows:

  • Body part or nature of injury is reviewed
  • Appropriate medication plan is assigned
  • Date of injury dictates acute versus long term medication plan
  • Generic medications are dispensed whenever appropriate


INTERVENTION RX™

Progressive Medical’s Intervention RX program is a compilation of a pharmacist and or a physician providing an in-depth clinical review, analysis and report of an injured party’s medication usage. The report will ensure that your injured party’s medication usage is appropriate and proactively plan and prepare


PHARMACEUTICAL COST PROJECTIONS

A comprehensive Pharmaceutical Cost Projection report can be completed based upon the client’s recommendation. Review of prescription drug history and medical records are performed by our clinical pharmaceutical team.

The review ensures that only diagnosis and age appropriate treatment recommendations are included in the review.

  • Evaluations performed by clinical pharmacists to project reasonable and necessary treatment regimens for the allowed conditions
  • Cost projections based on current treatment program and best practice guidelines (evidence-based medicine)
  • Clinical pharmacists are available to collaborate with physicians to make appropriate treatment changes, if indicated, which may prove to be more cost-effective


ASK-A-PHARMACIST

Progressive Medical has pharmacists available during normal business hours to answer pharmacy questions. Clients are assured to get the answers needed when it comes to medication questions available via e-mail or through a dedicated toll-free line.