Drug VALUE Solutions

Changes to the review procedures for prescription allocations by the Centers for Medicare and Medicaid Services (CMS) have raised settlement costs higher than ever. PMSI continually acts as an industry advocate for clarification on the methodologies used in the CMS approval process and as a result developed our Drug VALUE Solutions to help clients close expensive claims while containing costs.
 
The Drug VALUE Solutions use an evidence-based, proprietary algorithm to calculate and reduce Medicare Set Asides (MSA) drug allocations. The algorithm is based on PMSI's experience as the only MSA provider in the industry with a long history of pharmacy expertise and knowledge.

Drug VALUE Review

Our proprietary Drug VALUE Review (DVR) helps reduce MSA allocations and leads to overall lower settlement costs. PMSI’s DVR is a comprehensive assessment and drug cost allocation forecast based on our industry expertise as a Pharmacy Benefit Manager (PBM) and published clinical research on drugs common to workers’ compensation and liability claims.

The DVR includes a detailed analysis of each drug and its impact on the future costs of prescriptions specific to the claim. The review assesses current medication utilization, confirms medications are appropriate for the primary injury, and evaluates appropriate medication utilization over the projected lifetime of the injured worker. In addition, the intricate algorithm looks at key factors that drive up prescription allocations and mitigates drug costs by assessing for tapering allowances, Medicare Coverage Guidelines, patent expirations, etc. A DVR allows you to settle more cases quickly, cost effectively and with confidence that you have the lowest defensible allocation.

The DVR is recommended for all claims that contain high-cost drugs as identified through the Drug VALUE Tool, PMSI’s proprietary drug assessment application. The cost savings realized through the use of the DVR are unequaled in the industry.

Drug VALUE Tool

PMSI's Drug VALUE Tool  uses a proprietary algorithm to calculate projected savings for a claim to determine if a comprehensive Drug VALUE Review (DVR) should be performed. The Drug VALUE Tool was the first mobile computing application for the workers’ compensation industry. It is a real-time solution that is available anytime, anywhere—from any iPhone, a desktop link or directly online. The complimentary program allows claims professionals to instantly calculate average costs of the current drug treatment over the life expectancy, and the projected savings if a Drug VALUE Review were performed.