FIVE REASONS WHY PHARMACY BENEFIT MANAGERS WORK BETTER

Worker’s compensation and automobile no-fault claims involving prescription drugs inherently contain several challenges for insurance companies. There are many ways to address these challenges, but the most effective involves a partnership between insurance companies and pharmacy benefit managers (PBM). This article will cover the top five reasons that PBMs work better than other options.

The first reason involves a significant impact on adjusters’ and examiners’ time. Experienced pharmacy benefit managers will be able to greatly reduce the administrative burden for adjusters and examiners by acting as a third-party administrator (TPA) of claims. By providing coordination of benefits with a claimants’ primary health insurance for auto no-fault benefits, a TPA allows adjusters and examiners to focus on adjudicating their claims efficiently and productively, eliminating the need for adjusters and examiners to spend their time on coordination of benefits related to copays and deductibles for auto no-fault benefits.

Secondly, a PBM will have negotiated discounted rates on pharmaceutical services for an insurance company and its claimants. These discounted rates are offered through a network of quality pharmaceutical service providers that an insurance company’s claimants have access to for all claim-related prescriptions.

Third, pharmacy benefit managers will be able to readily identify the appropriateness of prescriptions for an insurance company’s claimants. A pre-authorization process allows the PBM to ensure that all prescriptions being billed under a claim are directly related to that claim; once assured of injury relatedness, the claimant will pay no out-of-pocket cost for his or her prescription. Additionally, the PBM will identify the medical necessity of a dispense as written (DAW) drug and whether a generic drug is available and appropriate to substitute for the claimant.

The fourth reason a PBM is the best option for claims involving prescription drugs concerns the issue of compound medication billing. Pharmacies that are set-up to mix ingredients of medications that are customized for a specific patient are called compounding pharmacies. Compound medications are adjudicated differently since multiple medications are used in a recipe or formula in the compounded medication along with specialized equipment and pharmacy labor costs. Northwood processes claims according to a proprietary fee schedule in order to avoid unnecessarily high costs to the insurance company.

Finally, a PBM typically offers additional benefits to increase claimant satisfaction as well, such as home delivery services for prescriptions. If a claimant sustained catastrophic injuries while on the job or in an automobile accident and is unable to pick up his or her own prescriptions, a PBM will allow the appropriate prescriptions to be delivered directly to the claimant. This ensures the claimant access to the necessary medicine and increases claimant satisfaction with the insurance company.

These are but a sampling of reasons why a PBM works best for an insurance company administering workers’ compensation or automobile no-fault claims. Northwood has over 20 years of experience as a PBM and offers these benefits along with many more. If you have questions about the available benefits Northwood can offer to your company, please contact us at your convenience.

Visit https://www.northwoodinc.com/ to learn more. 

Auto Accidents Increase During Summer Months – Myth or Truth

People travel all year long. There are business travelers and people who travel for pleasure. There is an ebb and flow of the level of traffic during the year. The question becomes, are there certain times of the year where the auto accidents are greater? In this article, we will focus on the summer months. Is there an increase in accidents during the summer months over other times in the year?

During the summer months, children are out of school, and families go on vacation. This means that there is a higher level of traffic on the roads. Additionally, this can be a time when teenagers get their learning permits and practice driving. This also puts more people on the road and increases the number of inexperienced drivers.

People are generally more active in the summer months, so this means an increase in bicycles and pedestrians in the roadways. Also, kids are playing in their yards, so it is important to remain alert for the errant ball in the street. All of these equal more hazards for the roadways.

There has been an increase in distracted driving, mainly texting while driving. So, if there is an increase in hazards and a higher incidence of distracted driving, then the number of accidents will also increase. The summer months, due to the heat, increase the incidence of having a tire blowout. When that happens, the driver can lose control of the car and become a moving hazard for others on the road.

The National Highway Traffic Safety Administration has compiled statistics over the years that show that auto accidents increase during the months of August and September. The information above can offer a glimpse into why this could be. Knowing this information can help drivers be more vigilant when they are behind the wheel.

Everyone should always make sure they have their seatbelt fastened when in a moving vehicle. It is best to put the cell phone done or place it in driving mode when in the car. There are hands-free options available if the phone is used while the car is in motion. It is important before using the phone for any reason to determine if the phone use needs to be now, or if it can wait until the car is not in motion.

Remaining aware of the potential hazards while driving can help everyone be a safer driver. This is true for the summer months and all throughout the year.

 Visit https://www.northwoodinc.com for more information.

ISSUES IN ALTERNATIVE DRUG THERAPY

Complementary and alternative drug therapy is becoming more popular among consumers. CNN reports that in 2015, more than 33 percent of people in the United States were searching for assistance with their health issues from somewhere other than their primary medical doctor. These alternative treatments are typically used in conjunction with traditional medicine, but about five percent of the 89,000 participants in the National Health Statistics Report cited by CNN were seeking out alternative therapies to be used without prescription drugs.

While the benefits of alternative therapy are debatable, there are many more known issues and potential problems associated with it. The vast majority of available alternative drug therapy options are not regulated by the Food and Drug Administration (FDA) and may pose a significant risk to claimants due to the lack of industry standards for a particular therapy. Supplements and other alternative drugs taken orally may interact with prescribed medicines and cause health complications or even fatalities in extreme cases. These health complications and negative interactions may ultimately mean higher medical costs to an insurance company due to the additional recuperation time needed for their claimants with injuries from an automobile accident or workers’ compensation incident.

Northwood acts as a Pharmacy Benefit Manager (PBM) for an insurance company’s auto no-fault or workers’ compensation claims to assist in reducing claims cost and help minimize the issues that can arise with alternative drug therapies. By implementing a pre-authorization process for all claims involving prescription drugs, Northwood can help assure all claimant prescriptions are injury related. This not only eliminates unnecessary costs to the insurance company but also reduces the chance of drug interactions for claimants by connecting the claimant directly with a trusted pharmaceutical provider to help ensure prescription drug regimens are followed.

Highly qualified and extensively trained staff members are available each day at Northwood. The staff at Northwood is skilled in the use of prescription drugs and is familiar with types and dosage of drugs, further assuring the injury relatedness of all claimant prescriptions. Insurance companies and their claimants will also gain access to a network of high-quality, credentialed medical providers who provide discounted prescription rates for Northwood’s clients. This network spans the United States and Puerto Rico and allows claimants to receive their prescriptions without paying out-of-pocket costs. Claimants are also free to inquire of the pharmacy providers in this network about potential interactions with alternative drug therapies they may be using. Providing this resource for claimants allows for a significant reduction in drug interactions and helps hold down the cost of claims involving prescription drugs.

For more information regarding issues with alternative drug therapy or Northwood’s ability to help address and minimize the associated issues while saving money for insurance companies and claimants, please contact us at your convenience.

MICHIGAN’S AUTO INSURANCE AMONG THE HIGHEST IN THE NATION

Michigan residents are well aware that their auto insurance premiums are continuing to rise. According to the Detroit Free Press, auto insurance rates in Michigan have been steadily increasing since 2009. Insure.com reports that as of 2016, the state of Michigan has the costliest auto insurance rates in the entire United States. In fact, Michigan has had either the most or the second most expensive car insurance premiums for the previous six years in a row.

Numerous factors may play a part in these rising auto insurance premiums, but the largest variable pertains to Michigan’s unique automobile no-fault coverage. Many states in the nation offer a variation of auto no-fault coverage for their clients, but Michigan is the only state in the U.S. to provide unlimited no-fault coverage for those injured in an auto accident. Furthermore, injured claimants are eligible to receive payment for up to three years of covered wages if they were unable to return to work due to injuries sustained in an auto accident. This generous auto no-fault coverage comes at an incredibly high cost, both to insurance companies and their insureds. The Detroit Free Press reported that insurance companies in Michigan incurred nearly three billion dollars’ worth of costs for the 44,620 no-fault claims in 2012.

While the state’s no-fault coverage may play a significant role in the rising cost of auto insurance, the advancing technology and rising costs of medical treatments and prescription drugs also affect Michigan residents’ premiums. Customized wheelchairs and other rehabilitation equipment are sometimes prescribed for injured claimants, for example. Insurance companies can quickly see a rise in overall auto no-fault medical claims costs if they are not proactive in controlling expenses.

Insurance companies may not be able to bring immediate change to Michigan’s no-fault laws or control the costs of rapidly advancing technology, but they do have an option to help hold down auto insurance rates for their claimants. Northwood is a trusted and highly experienced third-party administrator (TPA) of auto no-fault claims and can assist insurance companies with the rising costs associated with these claims. Through its credentialed and extensive network, Northwood offers insurance companies the opportunity to provide reduced rates on medical services to their claimants, with no out-of-pocket cost involved. Northwood also offers highly trained customer service staff members who are available 24 hours per day and seven days per week, ensuring high levels of claimant satisfaction.

By partnering with a TPA such as Northwood, insurance companies will realize significantly reduced auto no-fault claims costs. As these cost-saving measures are implemented, insurance companies will be better able to hold down further increasing auto insurance premiums for their insureds. Proactive management of no-fault claims is vital to an insurance company’s success, and representatives from Northwood are available to assist with providing additional information.

Reference: https://www.northwoodinc.com/michigans-auto-insurance-among-highest-nation/