Pharmacy Solutions

Total PBM Management

CorVel offers a full spectrum of prospective PBM management, risk identification and mitigation and pharmacy bill review. At our core, we are medical management experts. From first fill, eligibility and formulary management, to real-time drug utilization review and mail order management, CorVel delivers industry leading savings.

We offer a high touch model through our team of Certified Pharmacy Technicians who interface with pharmacies and adjusters on a daily basis. Our clients are empowered by our integrated interface, CareMC that delivers intuitive support tools to expedite decision making and manage patient risk.

Total Exposure
CorVel’s pharmacy program delivers industry leading value through integration with our bill review system that provides 100% visibility into pharmacy data to effectively manage exposures and costs from all angles. This allows CorVel to identify and address pharmacy transactions that were not prospectively managed including out of network bills, paper bills, third party bills and physician dispensing.

Drug Utilization
We offer a full spectrum of drug utilization review services to ensure injured workers are receiving the most appropriate medications in the most cost effective manner. Services include customized formularies, point of sale edits to ensure appropriate dispensing at the pharmacy, retrospective review of out of network bills, and a medication review program that works directly with treating physicians to reduce costs.

Managed Dispensing
At CorVel, we do not just view untracked pharmacy bills, we act on them. CorVel’s pharmacy bill review and our provider relations team leverage our contracts and direct provider relationships, driving prospective PBM management. Our integrated system identifies exposures from unsafe practices and high risk behaviors, while our team of medical management experts apply data, technology and experience to truly manage provider and injured worker behavior. By addressing key indicators at the front end through adjuster alerts that require affirmative responses and actionable data, prospective management promotes accuracy in concurrent interventions and ultimately drives safe pharmacy utilization practices.

Patient Risk
What you don’t know about your true pharmacy spend could be hurting you, your employees and your bottom line. At CorVel, we not only help manage total financial exposure, but also your injured workers' risk. Landmark court rulings have set new precedents for extending employers’ liability, raising risk managers’ concerns about abuse of prescription medications. Leveraging CorVel for pharmacy management can be an advantage. We offer more visibility to improve patient safety and minimize risk. Our program improves reduced risk of overdose, no risk of interacting medications and reduced exposure to the risks of opioid addiction, all of which contribute to significant savings and better care delivery for patients.