Prescriptions costs represent a significant share of workers’ compensation costs. According to a NCCI report released in 2018, the projected prescription drug share of total workers’ compensation medical costs is about 14 percent. Opioid abuse, physician dispensing and compounds are the top three cost drivers.
To address these concerns and bring meaningful change to workers’ compensation, cooperation between stakeholders is required. Our approach to standards development through inclusive engagement with a range of stakeholders uniquely qualifies URAC to support these efforts.
The URAC Difference
URAC’s accreditation process develops a framework for a patient-centered approach that ensures information is shared across providers and payers, aims to achieve the best possible outcome for the patient and ultimately manages the rising pharmacy costs of workers’ compensation.
The URAC-accredited Workers’ compensation and property & casualty pharmacy benefit management program:
- Ensures drug management mechanisms that address therapeutic appropriateness, overutilization and underutilization, generic use, drug dosage, duration of treatment, clinical abuse or misuse and more
- Demonstrates the capability to inform claimants receiving benefits about available information resources and assistance
- Follows ongoing communications practices that monitor existing materials for accuracy, and updates them as changes are made to clearly and accurately communicate information
- Operates a call center for inbound and outbound calls and meets specific operating requirements
- Maintains policies and procedures for clinical communications
- Presents and delivers information in ways that are appropriate to the diversity of the organization’s enrollment, including literacy levels, language differences, cultural differences and cognitive or physical impairments
- Supports electronic prescribing and can integrate with its drug management systems
- Has processes and procedures in place to identify, analyze and rectify drug and consumer safety issues
What to Expect
Within six months or less, URAC collaborates with your team to assess your approach and creates a flexible framework for continuous improvement. While our experts define the standards of excellence, they do not prescribe how your organization should meet those standards.
URAC’s approach stimulates innovation across the continuum of care through email, conference calls and educational webinars.
We award accreditation for a full three years. Download our Workers Compensation and Property & Casualty Pharmacy Benefit Management Standards-at-a-Glance for more information.
Who May Apply
Organizations that manage a workers’ compensation program inclusive of drug management, such as a workers’ compensation carrier or a pharmacy benefit management company, may apply for accreditation.