Pharmacy

Participants in our pharmacy program have access to an extensive network with over 60,000 pharmacies throughout the United States. Pharmacy eligibility is established during the intake process. The injured worker is able to fill their prescription without any out-of-pocket expense.

Benefits

  • The First MCO / 4-D Pharmacy program for Workers’ Comp claims has the best discounts on the market.
  • Prescription fills are monitored and quality controlled to ensure any approved drugs are workers' comp related.
  • Developed a tightly controlled Formulary of workers’ comp related drugs allowing the majority of pain related drugs to be issued without special approval by the adjusters or case managers. For certain drugs outside the formulary, such as Oxycontin, Valium and Neurontin, approval is required from the adjuster or case manger before the Pharmacist can dispense the drug.
  • For case managed claims, a nurse is available 24 x 7 to approve any Pharmacy requests.
  • For Re-Price Only claims, a nurse is available 24 x 7 to receive any Pharmacy requests and will forward that request on to an authorized Account adjuster for approval.
  • Special restrictions or overrides can be coded into the system for a case where it has been determined there has been abuse or where it is clear that a non-formulary drug is required long term.
  • A Pharmacy card with the patient's name and claim # will be mailed directly to the employee.
  • The claim information is electronically sent to 4-D within minutes of having received the information from the employee, nurse or other authorized party.
  • For our case managed claims, if the patient is near a fax or has access to email, we can issue a temporary card immediately so that they can use it to get their first fill scripts onto the program. This allows us to secure discounts and control the types of drugs the patient might receive.

 

 

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