Pharmacy Management

Through our partnership with PRIUM, Franco Signor provides comprehensive Pharmacy Management Solutions for our clients. This partnership combines Franco Signor’s expertise in MSP Compliance and Mandatory Insurance Reporting (MIR) with PRIUM technology and strong clinically-based pharmacy and case management services.

Pharmacy Management Program Overview

Medicare Set-Aside (MSA) Allocations are impacted by high prescription costs and inconsistent review practices from the Workers’ Compensation Review Contractor (WCRC). It has been proven that the best way to control these costs is to address the prescription drug spend before settling the claim and submitting to Medicare. PRIUM, powered by Franco Signor, can identify cases that are exposed to large prescription drug costs using proprietary claim triggers and manage these costs back to a place where the case can be settled with an approved MSA.

Rx Review Service

This service is recommended on active allocation files with high Rx costs to assist in controlling costs of prescription drugs. Review is completed by our team of Physicians, Pharmacists, and Pain Management Specialists to obtain maximum reductions.

We provide alternative drug settlement options based on the following:

• Medication Usage (off-label, etc.)
• Generic Substitutions
• Drug Interactions (contraindicating combinations by manufacture)
• Inappropriate Dosage or Duration according to PDR
• Inappropriate Drug Utilization
• Duplication (multiple drugs providing same effect)
• Possible surgical interventions to reduce or eliminate use

Rx Peer-to-Peer Service

Rx Peer-to-Peer Service is a retrospective drug utilization review program that leverages the expertise of licensed, practicing physicians and the use of evidence-based medicine to identify alternative medication prescribing. In this comprehensive review of a patient’s entire medical and prescription history, our clinical staff engages the prescribing physician in order to mutually agree on an appropriate course of treatment. Due to its demonstrated results, Rx Peer-to-Peer Service is our most successful retrospective clinical program.

Customers Who Use the Rx Peer-to-Peer Service Program Benefit From:

• Non-biased physician review of the injured worker’s medical and prescription histories
• Consultation with the prescribing physician(s) to determine medically appropriate, lower-cost alternatives
• Increased compliance and savings
• Follow-up by telephonic nurse support helps to ensure compliance with the agreed-upon changes to the injured worker’s medication therapy plan.

Medical Case Oversight

Our nurse case management division provides the oversight necessary to transform the recommendations into reality. A nurse case manager will assist the claimant while following the recommended weaning and discontinuance schedule. This engagement will continue until the recommended modifications have been fully executed or until a time that our client is satisfied with the progress being made.

 

For more information about these services, engage us today at: engage@francosignor.com

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