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DULUTH, GA (Jan. 06, 2012) ― PRIUM and Allsup Medicare Secondary Payer Compliance Services have joined forces to address pharmacy regimens and costs before submitting Medicare Set-Aside arrangements to the Centers for Medicare and Medicaid Services (CMS).
“Skyrocketing pharmacy costs are impacting settlements, and Drug Utilization Reviews are not solely enough to receive CMS approval for drug costs,” said Rob Sokol, director of Medicare Secondary Payer Compliance for Allsup. “CMS needs the primary treating physician’s written agreement and proof of medication changes to remove drug costs from the calculation, and that’s where PRIUM’s Physician Pharmaceutical Review (PPR) comes in.”
When casualty claims meet a financial or drug utilization threshold, Allsup recommends that clients engage PRIUM’s services to work with the treating physician to adjust the regimen prior to submitting the MSA to CMS for review. PRIUM’s physicians use evidence-based medicine and their practice experiences to identify the most clinically appropriate and related drug therapy with the treating physicians.
“Collegial physician to physician discussions produce agreement on a new drug treatment plan in 67 percent of our cases, and then our case management oversight helps implement the changes,” said Mark Pew, PRIUM’s senior vice president of business development.
While focusing on patient safety and quality of life, drug therapy changes typically result in lower drug costs. “The average claim’s actual savings was $8,575, yielding a return on investment of $6.65 for every dollar spent with us,” Pew added, noting the projected savings on an average claim was $33,244 over 24 months.
The combined expertise and skills of Allsup and PRIUM professionals will help drive optimum results for casualty claim settlements and Medicare compliance, while also producing positive benefits for claimants.
ABOUT PRIUM
Based in Duluth, Ga., PRIUM is a medical cost management company providing physician pharmaceutical reviews, independent medical exams and peer review to the workers’ compensation industry. To reach PRIUM, call 888-588-4964 or visit www.prium.net.