Rx costs continue to be the single fastest-growing expense in the Workers’ Compensation arena. To offset these cost, clients can take advantage of Excel’s specialized Rx Review program. Our physicians will thoroughly evaluate each case individually and determine appropriate medications based on file facts, including type of injury, response to medical treatment, and Rx usage.
An Rx review will provide the client and treating physician with the following information in a detailed report:
- Whether the drugs prescribed are appropriate for the type of injury
- Whether the physician prescribed a “cocktail” in which drugs overlap one another
- Whether generic drugs can be substituted for brand
A peer-to-peer phone call takes place to discuss a detailed weaning plan that is supported by the peer review physician and treating physician and outlined in the final report
Rx reviews performed regularly will positively impact medical cost and ensure appropriate drug usage. Our clients realize an average of $2,685 in net savings with each Rx Review referral.
When to Assign to Rx Review
The claim staff consider the following list as possible triggers when assigning to Rx review:
- The date of injury (DOI) is greater than 8 months
- The diagnosis does not match the prescriptions and treatment
- The Pain Specialist is the primary treating physician and/or drugs prescribed are identified as high risk opioids.
- Monthly Rx costs are $600 or more
Future Medical Reviews
At the request of our clients, Excel’s Medical Director will perform a future medical review that provides a detailed report using ACOEM/MTUS and ODG Guidelines to document the expected type and frequency of medical treatment. Medical reviews assist the adjuster in setting accurate reserves and establish a plan of action (POA) to move case to closure.