If you search the function of a pharmacy benefit manager (PBM), the internet responds with “an intermediary between health plans, pharmacies, and drug manufacturers to negotiate drug prices and manage prescription drug benefits.” This is true, but they can and should do so much more.
There are stark differences between a PBM that is just processing transactions for a discount vs. a PBM partner that is actively managing claims in the best interests of the client and the injured worker. If you aren’t working with the latter, you are leaving money on the table.
A pharmacy network and clinical services are functions of a PBM that are critical to nearly every pharmacy transaction. In his latest WorkCompWire Leaders Speak, Mike Cirillo, president of MyMatrixx by Evernorth, reviews several “other” PBM services may impact a smaller percentage of pharmacy claims, but without them, payers will miss opportunities to lower costs and improve their injured workers’ care and safety.
Click to read more about the value of Fraud, Waste & Abuse and Out-of-Network Management solutions and why payers need to think big and expect their workers’ compensation PBM to be not just a resource but a partner.