Prescriptions costs represent a significant share of workers’ compensation costs. According to a NCCI report released in 2016 (https://www.ncci.com/Articles/Documents/II_IR2016-Complete.pdf), the projected prescription drug share of total workers’compensation medical costs for the accident year 2014 is 17 percent. Plus, 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
URAC’s accreditation process develops a framework for a patient-centered approach that ensures information is shared across providers and payers, helps to get 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 has the ability to integrate with its drug management systems.
- Has processes and procedures in place to identify, analyze, and rectify drug and consumer safety issues
- And more.
Download our Workers Compensation and Property & Casualty Pharmacy Benefit Management Standards-at-a-Glance.
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.