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Pharmacy Intervention Program

Fundamental Value

Safely and effectively reducing inappropriate medication therapy from the treatment plan of an injured worker is one of the biggest challenges facing the workers’ compensation industry today. Efforts to prevent and eliminate dangerous medications for newer injuries have been very successful. However, there is a large group of patients that still need help with their complex medication plans.

Staged Approach

Arbicare's Pharmacy Intervention Program utilizes a staged approach that we have found most effective in achieving the desired clinical outcomes. The program is led by a team of expert clinical advisors, including Arbicare's medical director, specialized in occupational medicine and addiction management. This expert clinical team collaborates closely with each claim stakeholder to provide an action plan. Depending on the context of the case, that action plan may include engagement with each of the treating physicians, the injured worker, and the retail pharmacy. Engagement is routine and ongoing until an appropriate treatment plan is implemented.

While injecting evidence-based care into a long-term treatment plan is challenging, clinical outcomes can be achieved, and lives can be saved. It takes consistent effort and compassion by the right group of clinical leaders. With Arbicare's Pharmacy Intervention Program, that's exactly what you get.

01

Assess

Consultative Clinical Assessment

  • In-depth review of all treatment history by expert clinical advisors
  • Delivery of review documenting cost drivers and action plan
  • Conference call with the Clinical Advisors to discuss action plan and next steps
02

Discuss

Peer to Peer Discussion

  • Medical Director led peer to peer discussion
  • Focus on the agreed action plan
  • Educate the claims team on the outcomes
  • Assignment to MTM to track agreements
03

Manage

Medication Therapy Management

  • Pharmacist-led follow-up with prescriber, patient, and retail pharmacy
  • Routine status updates
  • Focus on easiest medication changes first
  • Transition UR to expert clinical advisors for continuity
04

Advise

Ongoing Clinical Advisory Meetings

  • Stakeholders reconvene for status update and revised next steps if necessary
  • Conference call with our Clinical Advisors
  • Quarterly meetings
  • Clinical and medical/legal options considered

Customer Results

59%

Discussion Rate

79%

Agreement Rate

Average 2 Year Savings Per Claim

$15,054

Better Care, Improved Relationships, Clinical Outcomes

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