Workers' Compensation Prescription Drug Card Program

• Comprehensive solutions for pharmaceutical needs.
• Group of programs offers a full spectrum of services:
  • seamlessly weave "first-fill" ID card programs
  • cardless capabilities
  • retrospective bill review networks
• Unique answers to the prescription drug concerns of the injured worker, employer and payor.

How the Program Works

From Injury to First Prescription Filled

• Injured Worker reports claim to his/her supervisor.
• Injured worker receives their ID card through several processes.
• Injured Workers presents card to the Pharmacist.

From Injury to Second Prescription Filled

• Injury reported to client.
• First prescription paid by client at fee schedule.
• PharmacyComp™ card sent to injured worker by PharmacyComp™.
• Injured worker presents card to the Pharmacist for all future prescriptions filled for his/her injury.

PharmacyComp™ -- a Unique Program

Resolves the Workers' Compensation Prescription concerns of:

• The Injured Worker
• The Employer
• The Claim Examiner
• The Client

Resolves the Workers' Compensation Prescription concerns of injured worker:

• No out-of-pocket expenses.
• No paperwork to complete.
• No reimbursements by the Client.
• Easy to use Simply present the ID card to the pharmacist.

Advantages of PharmacyComp™

To Client:

• Enjoy similar savings for WC drugs as in group health arena.
• Eliminate "dual prescription fills."
• Less Paperwork.
• Reduce claim costs with DUR.
• Receives Re-Pricing from Retail to State Fee Schedule.
• Reduces the Workload for examiners, assistants, staff, etc.
• Eliminates the need to process prescription bills.
• Eliminates late payments and penalties.
• Claim data transferred electronically into payment system.
• Saves client $ (cost of prescriptions and overall claim costs).
• Offers client access to over 50,000 pharmacies nationwide.
• Save $1.50 - $4.50* per bill by not requiring the services of a Bill Review Company (which generates savings of ~13% by repricing from Retail to State Fees).
• Save $3.00 - $8.00* per bill by not having to process and mail checks to pharmacies.
• Save up to 15% on Name Brand drugs (below State Fees).
• Save up to 65% on Generic drugs (below State Fees).
• Over 90% of the time, substantial savings found by switching to Generics from prescribed Single Source Brand drugs when using the PharmacyComp™ Network.

* Figures based on InterMed Bill Review Services pricing

To the Claim Examiner:

• Eliminates data entry and the need to process a bill for the claim examiner, assistants and file clerks.
• Reduces authorization phone calls from the pharmacies.
• Eliminates check processing to pharmacies.
• Eliminates phone calls regarding outstanding invoices.

Drug Utilization Review Services

• A team of specialized clinical pharmacists and staff, dedicated to analyzing prescription claims data.
• Review claims, provide additional DUR, watch practice patterns of physicians.
• Present therapeutic options to physicians based on national guidelines and protocols.

How the Program Works

From Injury to Prescription Filled

• Pharmacist enters information into computer system.
• In .49 seconds, the system verifies:
  1. eligibility,
  2. coverage within WC formulary, and
  3. switches to generic products when possible
• Pharmacist dispenses approved drug.
• Pharmacist is paid directly by PharmacyComp™ twice a month.

Data Flow From the Pharmacy to Client

• All Claims data is sent electronically to PharmacyComp™
• Nightly, PharmacyComp™ e-mails to client the "Early Notification Report."
• Weekly, PharmacyComp™ transfers claims data directly into claim payment system.
• PharmacyComp™ bills client each week for claims and administrative fees.

Flow Chart of PharmacyComp™

Nightly Transmissions Available -- from client's Claim System to PharmacyComp™:

• New Open Claims with Claim Number
• Claims which were Delayed, Pended, Closed, etc.
• Any changed data from working the file, including turning on/off the following:
  • NDC Numbers -- Specific Drug (11 digit # after Rx name)
  • ICD9 Codes -- Diagnosis (International Classification of Diseases)
  • I.D. Cards -- Injured Worker

Weekly Transmissions Available --  from PharmacyComp™ to client’s Claim System:

•  Injured Worker’s Name & SS#
• Date of Injury, Date Filled
• Name of Rx and Physician
• NDC #, Dosage, Days Supply
• DEA#, Claim #, etc.
• Retail Charge and Negotiated
• Rate paid to the Pharmacy

In Summary

• Simplified access for the Injured Worker.
• Reduces complaints to Employers re: reimbursements for out-of-pocket expenses.
• Cost savings for client:
  • Prescription Repricing to State Fee Schedule at no charge
  • Substantial Claim Cost savings
  • Substantial reduction in Claim Processing costs.