Pharmacy Benefit Management
Compliance, Savings, Satisfaction
Driven by outcomes
Prescription drugs are among the earliest needs of injured workers. With this in mind, First MCO has built a pharmacy program enabling injured workers to get their injury-related prescriptions quickly and without hassle or out-of-pocket expense.
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.
Formulary of workers’ compensation related drugs allow 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 manager before the pharmacist can dispense the drug.
The First MCO Difference
- Save on pharmacy costs. The First MCO / SmithRX Pharmacy program for Workers’ Comp claims has the best discounts on the market.
- Improve program compliance. Prescription fills are monitored and quality controlled to ensure any approved drugs are injury related. 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.
- Drive penetration. The claim information is electronically sent to SmithRX within minutes of having received the information from the employee, nurse or other authorized party. A Pharmacy card with the patient’s name and claim # will be mailed directly to the employee and an electronic version of the Pharmacy ID card is sent directly to the injured worker’s mobile phone.
- Maximize satisfaction with 24/7 access. For case managed claims, a nurse is available 24/7 to approve any Pharmacy requests. For Re-Price Only claims, a nurse is available 24/7 to receive any Pharmacy requests and will forward that request on to an authorized Account adjuster for approval.
FIRST MCO WORKERS’ COMPENSATION SERVICES