The Hidden Benefits of The Hartford’s Work Comp Drug Review

The Hartford’s Drug Review is a differentiating factor that helps provide cost-effective workers’ compensation that your customers will appreciate. It helps ensure accuracy and appropriateness in approving prescription drugs for work-related injuries. The benefits include:

·         Protecting the injured worker’s health

·          Ensuring  your customer’s premium dollars are applied accurately

·         Enhances The Hartford’s ability to deliver cost-effective workers’ compensation coverage 

While industry spending on workers’ compensation pharmacy expenses increased 8-10% between 2002-2005, The Hartford held increases to 3-5%. 

By monitoring and reviewing prescriptions that fall outside of our unique, proprietary drug formularies* or accepted evidence-based medical practices, we can verify that prescribed drugs are related to covered injuries, avoid covering drugs unrelated to workplace injuries, and avoid fraud. In 2006, this process accounted for savings of nearly $1.5 million. 

In the face of increasing workers’ compensation pharmacy costs, your customers need an insurer skilled in managing those costs. Here’s how we do it: 

Monitoring Prescriptions

The Hartford contracts with the pharmacy benefit management vendor Tmesys™, which provides a network of more than 50,000 pharmacies and the electronic system for monitoring and administering prescriptions. Into this system, Tmesys incorporates The Hartford’s formularies, which are lists of drugs and pharmaceuticals approved for use with certain injuries within certain timeframes. When Tmesys encounters a case that falls outside of the formularies or that reaches a predetermined cost threshold, it notifies The Hartford, which then reviews the case. 

Drug Review Nurses

To review prescriptions that fall outside the formularies or evidence-based medical practices, The Hartford employs a team of Drug Review Nurses. These nurses evaluate the particulars of each case, considering the specifics of the injury and ongoing treatment, as well as the accepted practices of evidence-based medicine. About 65 percent of the cases they review are assessed as being appropriate to the covered workplace injury. In cases where a prescription is assessed as inappropriate, the nurses alert the claims handler, who determines how to address the situation. This can result in further investigation, including contact with the doctor, and possibly denial of payment. 

Rather than boiling down important decisions to a set of rules, this process allows nurses to apply their professional judgment to each situation. This protects the injured employee, ensuring that he or she receives the most appropriate medication for an injury. At the same time, it allows us to protect your customers, ensuring their premium dollars are applied accurately and fairly. 

Contact your local sales representative to learn more about The Hartford’s workers’ compensation programs. 

*The Hartford applies formularies only in states where they are allowed.