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 Physician Pharmacy Review 


The prominent use of powerful, addictive narcotics in the workers’ compensation system drives 25% of the industry’s Rx costs, according to NCCI. Prescription drug overuse increases your claim costs and employee recovery times, health risks and overdoses. Additionally, injured employees dealing with pain and the pain medicine cycle often experience impairment that makes returning to work impossible.

Your Rx & Return-to-Work Results
Rising’s Physician Pharmacy Review program takes action on drug misuse and abuse, so you can:

•     Decrease the time and manpower needed to identify at-risk cases
•     Act early and proactively
•     Reduce employee addiction potential
•     Improve employee health outcomes and productivity
•     Increase return-to-work probabilities
•     Cut prescription costs
•     Lower indemnity costs

5 Steps to Early Intervention
Avoid unnecessary medical and indemnity expense through early detection of questionable prescription usage behavior. Rising intervenes with five proven steps that reduce your claim costs.

Step 1: Rx Intelligence
Our Rx Intelligence pharmacy analytics flag your at-risk cases by tracking prescription activity, including:

•     Fill dates
•     Number of fills
•     Usage days
•     Average fill interval days
•     Dosage amounts
•     Urine drug screenings
•     Costs
•     Prescriptions from multiple providers
•     Escalation and weaning patterns

Step 2: Nurse Drug Evaluation
Rising nurses alert you to cases that may benefit from a Physician Pharmacy Review.

Step 3: Physician Pharmacy Review
Our pain management physician reviewer contacts the prescribing physician with recommendations (i.e. medication alternatives, frequency, dosage and/or a weaning program).

Step 4: Tracking

Rising’s Rx Intelligence technologies track the case to assess positive improvements.

Step 5: Telephonic Case Management (optional)
Rising’s telephonic case management can be used to ensure the physician reviewer’s recommendations are implemented.

5 Key Questions to Ask About Your Pharmacy Evaluation Program

  1. Does it provide a complete medical picture or is it limited to prescription fill information?
  2. Is it proactive and actionable? Does it identify questionable activity early in the claim?
  3. Are drug screens included in your dataset, and does your solution show if drug screens are being over or underused?
  4. Does it show the prescribing activity for all drugs, not just opioids, and identify escalation or weaning patterns?
  5. Can you easily see prescriptions from multiple providers?








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