Express Scripts Workers' Compensation Solution Helps Payers Address the Rising Cost of Physician Dispensing

Feb 27, 2014, 08:30 ET from Express Scripts

ST. LOUIS, Feb. 27, 2014 /PRNewswire/ -- Medications dispensed through a physician's office are often repackaged and priced as much as 60 to 300 percent higher than an identical drug dispensed at a pharmacy to workers receiving treatment due to on-the-job injuries. Today, Express Scripts (NASDAQ: ESRX) announced the launch of a new Physician-Dispensed Medication Solution to provide workers' compensation payers visibility into their true total pharmacy costs and help reduce costs resulting from  physician dispensing of medications.


"When drugs are repackaged for physician-dispensing, the price is significantly inflated and those costs get passed on to the payers," said Jennifer Kaburick, vice president, Workers' Compensation Product Management & Strategic Initiatives. "Processing bills for physician-dispensed medications through our enhanced adjudication system helps payers reduce costs, while staying compliant with state workers' compensation laws that address physician dispensing."

Express Scripts' Physician-Dispensed Medication Solution uses comprehensive pharmacy data to review prescriptions and issue appropriate payment. The system checks medications billed by a physician's office against the payer's formulary and plan design, the injured worker's prescription history and specific state guidelines. This helps reduce costs and drive out waste.

Some states require physicians to bill payers using the original National Drug Code price; other states prohibit the practice all together. The Express Scripts' solution is completely customizable based on the state jurisdiction.

Solution Promotes Safety of Injured Workers

In addition to reducing waste from physician dispensing, the program also helps ensure injured worker safety.

"When injured workers receive medication through a doctor's office – especially one that is not the primary treating physician – they are at risk for potential drug interactions or duplication of therapy," said Kaburick. "Physician-dispensed medications also lack the point-of-sale safety edits that a pharmacy can provide."

In addition to providing payment according to state guidelines, Express Scripts' physician dispensing solution also leverages the company's insight from behavioral science research to encourage injured workers to make better decisions about their own treatment and help control costs. Express Scripts sends educational letters to injured workers who have received medication from a doctor's office, highlighting the cost impact of their decision on their employers and encouraging them to fill future prescriptions through an in-network pharmacy or the Express Scripts home delivery pharmacy.

"Applying a 'social responsibility' message can encourage injured workers to make better decisions about their pharmacy choices. Our previous research demonstrated that those who received a letter based on that behavioral science principle were 60% more likely to choose a generic than those who did not, despite the lack of personal financial incentive," said Kaburick. "We are applying the findings of our research and pilots to help workers' compensation payers save money and ensure better treatment outcomes for injured workers."

About Express Scripts

Express Scripts (NASDAQ: ESRX) manages more than a billion prescriptions each year for tens of millions of patients. On behalf of our clients — employers, health plans, unions and government health programs — we make the use of prescription drugs safer and more affordable. Express Scripts uniquely combines three capabilities — behavioral sciences, clinical specialization and actionable data — to create Health Decision ScienceSM, our innovative approach to help individuals make the best drug choices, pharmacy choices and health choices. Better decisions mean healthier outcomes.

Headquartered in St. Louis, Express Scripts provides integrated pharmacy-benefit management services, including network-pharmacy claims processing, home delivery, specialty benefit management, benefit-design consultation, drug-utilization review, formulary management, and medical and drug data analysis services. The company also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services.

For more information, visit or follow @ExpressScripts on Twitter.

MEDIA CONTACT: Riddhi Trivedi-St. Clair Office: 314-684-6665

SOURCE Express Scripts