Pharmacists Enhance PBM Effectiveness in Workers’ Comp and Auto No-Fault Sectors

Pharmacists are playing an increasingly vital role in Pharmacy Benefit Management (PBM) programs, particularly in the workers’ compensation and auto no-fault sectors. Their responsibilities have expanded beyond traditional roles, now involving the assessment of medication utilization, the review of new drugs, and ensuring appropriate prescriptions. Tron Emptage, Chief Clinical Officer at Optum Workers’ Comp and Auto No-Fault, emphasizes the importance of staying current with evolving drug information and utilizing analytical software to improve patient outcomes.

In PBMs, pharmacists engage in various activities such as creating and reviewing formularies, identifying appropriate medications for specific injuries, and conducting clinical roundtables. They also play a crucial role in fraud detection and medication misuse prevention. Adrienne Harris, Associate Director of Clinical Services at Optum, highlights the importance of empathizing with patients and focusing on their care needs.

The diverse backgrounds of pharmacists in large PBMs are beneficial. For example, a pharmacist with hospice experience may offer valuable insights into opioid management, while one with hospital experience might be adept at navigating treatment protocols. This diversity is especially useful in addressing mental health challenges, a growing concern in workers’ comp, particularly for conditions like PTSD in first responders. Emptage points out that having pharmacists with varied experiences helps in tailoring treatment recommendations to individual needs.

Large PBMs are advantageous due to their ability to provide diverse perspectives and tailored services based on a client’s needs. This is particularly beneficial for smaller clients without medical directors or case managers, as they can leverage the wide-ranging expertise of PBM pharmacists. Emptage likens choosing the right PBM to selecting an appropriate university, emphasizing the importance of matching resources to specific needs.