Pharmacy Solutions

Total PBM Management

When evaluating pharmacy spend, knowing the total exposure is key. While many PBMs claim up to 95% penetration, this number is deceiving. Typically, this reflects only in network transactions, not out of network bills which can represent as much as 40% of the true pharmacy exposure. From a single database, CorVel is able to review all transactions from all dispensing channels, including physician dispensers, third party services and alternate/mail order pharmacies.

Better information to manage total exposure.
What you don’t know about the 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's program can be an advantage. We offer more visibility to improve patient safety and minimize risk.

Proactive steps to improve pharmacy outcomes.
At CorVel, we do not just view untracked pharmacy bills, we act on them. We have exclusive resources dedicated to identifying and reindexing pharmacy claims. Closing these loops and correcting identification errors further increases reporting accuracy and improves penetration. Plus, because we utilize our own PPO network, we can leverage our provider relationships to limit physician dispensing. 

Tracking more formulary costs.
Our system tracks every in and out of network prescription from our proprietary integrated platform. CorVel increases penetration through effective data management, enabling us to leverage each opportunity to impact our clients’ results.

Tools that drive better return to work outcomes.
Our unique solution integrates Pharmacy Management, Clinical Modeling and Medical Review Services. Therefore, we can quickly spot variances in an injured worker's  prescription usage, triggering our expert panel of clinical pain management physicians to reach out to the treating physician to address issues as soon as they are identified. We can also examine a patient's entire drug history to determine medical necessity, consider alternate medications and treatments and ensure best practices for pain management. It’s the CorVel difference at work.  

In network Rx spending.
With access to a nationwide network of retail pharmacies, in addition to CorVel’s clinical expertise, investments in technology and customer service, our clients can benefit from significant reductions in their pharmacy program spend.

Our focus: Maximum penetration.
CorVel offers both a first fill and a pharmacy ID card program to maximize penetration into the pharmacy program. A mail order program is offered to injured workers with long term drug needs to ensure network utilization. We also proactively pursue out of network bills in order to redirect into the pharmacy program.

Brand-to-generic conversion.
Point-of-sale messaging to the pharmacy will indicate generic substitution is required for payment when a claim is transmitted online, unless the physician has specified dispense as written (DAW). DAWs are not dispensed automatically. CorVel’s formulary will trigger a prior authorization for all brand drugs with generic equivalents. CorVel will then call the prescribing physician’s office to request a substitution. Steering to generics will have a significant impact on overall pharmacy costs.

Improve utilization.
Our pharmacy solution offers a full spectrum of drug utilization review (DUR) services beginning with customized formularies through a medication review program that works directly with treating physicians to reduce costs. CorVel’s DUR programs promote quality care for injured workers while increasing savings for our clients. Our pharmacy benefit software provides point-of-service edits to manage utilization at the time of dispensing for superior results.

More integration.
CorVel’s pharmacy program delivers industry leading value through integration with our medical bill review system by identifying out of network bills, paper bills and third party bills and having them redirected into the pharmacy program. Ultimately, this results in more pharmacy bills being processed through the program creating significant savings for you. It also allows us to benchmark and track penetration across your entire pharmacy spend to more effectively manage your program.