Pharmacy chains demand higher payment for workers comp scripts. WC takes more work, as the pharm tech has to determine eligibility and do more work to get a script processed. Therefore, it’s logical that the chains charge more for WC.
Except that isn’t what’s happening.
Some of the rates that PBMs are offering their WC payers are so low that they have to be based on group health contracts. When you talk with the pharmacy chains, they state unequivocally that this is not possible, and if it is happening, and they find out about it, they will confront the PBM/payer and demand higher reimbursement.
Except that’s not what’s happening.
So, the WC PBMs that are doing the right thing, and processing their scripts according to their WC contracts, don’t stand a chance when they compete for payer business. Their rates are just too high compared to competing PBMs using group health rates.
One of two things is going to happen. Either all PBMs will start processing using group health rates, or the pharmacy chains will start enforcing their contracts.
The sooner the better.
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