The ‘new’ approach to work comp pharmacy

Today we take a deep dive into the very tiny pool of workers comp pharmacy benefit management – where there’s a recent development worthy of note.
The latest iteration of factoring company Third Party Solutions recently unveiled their new marketing strategy – at least it’s new to parent Stone River.
Stone River Pharmacy Solutions (SRPS) is repeating a strategy employed in the past by previous owners of TPS and WorkingRx – partner with retail pharmacies while simultaneously selling itself as a pharmacy benefit manager.
The pharmacy partnership’s value proposition is straight forward; less paperwork, faster pay, fewer hassles for the retail shops if they’ll sell their work comp scripts to SRPS.
Here’s their pitch to pharmacies:
“The bottom line is your bottom line. StoneRiver Pharmacy Solutions helps you build your business by containing administrative costs, increasing revenue and therefore profits…”
No mystery who their customer is – the retail pharmacy. Nothing new there.
What is somewhat new, well, at least new to SRPS, is the boldness of their approach to employers and other work comp payers. Remember, these are the folks who have been driving up pharmacy costs, reducing network penetration, suing insurance companies and PBMs, hassling adjusters and employers for payment, and otherwise making payers’ lives miserable for years.
But all that’s changed…
Here’s how SRPS puts it…
“Helping employers and payors care for injured employees while managing and reducing pharmacy-related cost is more than our mission. It is a commitment we live daily by delivering our industry-leading solution in workers’ compensation pharmacy care management.
We Ask. We Listen. We Carefully Consider. We Deliver!”
There’s a logical disconnect here; on the same webpage, SRPS claims to deliver “improved revenue and profits” to retail pharmacies. How, pray tell, can a vendor increase a provider’s revenues and profits while reducing payers’ pharmacy-related costs?
Anyone?
There’s more.
“Despite participation in workers’ compensation prescription programs, many employers and payors fail to achieve anticipated cost savings. Injured worker’s routinely don’t know or fail to identify the pharmacy program through which to process their workers’ compensation prescriptions; therefore, the pharmacy uses a default billing service. Until now default billing services have been unable to apply financial or clinical controls to these prescriptions. Without these controls prescriptions are processed out-of-network and higher priced medications or medications unrelated to the patient’s injury are dispensed.”
Hmmm, perhaps the copywriters haven’t kept abreast of the latest information on drug trends in workers comp. In fact, the trend rate for pharmacy has decreased each year for the last five years, and was below 5% last year. This at a time when PBM penetration was growing dramatically, clinical management programs were starting to deliver real results, and payers were aggressively contesting third party biller business practices.
Oh, and SRPS’ predecessor organizations were claiming they could apply ‘clinical and financial controls’ to scripts years ago. What’s different now? Well, SRPS has cleared out all the old management, so perhaps they have some new whiz-bang process, or, more likely, they don’t have the benefit of knowing what was tried – and failed – in the past.
What does this mean for you?
You’ve got to admire their chutzpah. Just make sure to keep your hand on your wallet.