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Your workers’ compensation pharmacy benefit manager About Us Clinical Aspects Information Technology
About Us ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
About Us ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
About Us KeyScripts is a workers’ compensation PBM serving insurance carriers and  self-insured employers in a market dominated by healthcare PBMs.
BEST PRACTICES DEVELOPED THROUGH 30 years of workers’ compensation management  and cost containment experience 50 years of clinical pharmacy experience About Us
Offers savings through OUR WORKERS’ COMPENSATION  FORMULARY Workers’ compensation driven Excludes unrelated healthcare drugs Reduces abuse, duplication and fraud About Us
Offers savings through PRIOR AUTHORIZATION 1. FORMULARY-DRIVEN Drugs are tagged for authorization prior to fill,  reducing costs associated with unrelated fills 2. ADJUSTER-DRIVEN Claimant-specific, as directed by the claims handler About Us
GENERIC SUBSTITUTION  Where available, and when brands are not  physician-mandated or requested by claimant Achieved through  KeyScripts WC Formulary About Us
Optional  FIRST FILL PROGRAM Temporary Prescription Benefit  Cards distributed  by employer when injury is reported Permanent cards then mailed to injured worker CARDS = COMPLIANCE = $$$ About Us
REVERSAL PROCEDURES Typically, invoices can be  reversed up to  7 DAYS AFTER FILL About Us
REVERSAL PROCEDURES AFTER 7 DAYS Adjuster or repricer provides  invoice to KeyScripts Pharmacy instructed to submit fills to KeyScripts Claimant reminded to take KeyScripts card to pharmacy About Us
Client had a 47% penetration  rate when KeyScripts assumed program management on 10/1/08 About Us
SAMPLE STATE PENETRATION (No. of Pharmacies) LA: 1,061 MS: 808 AR: 731 TX:  4,182 OK:  875 NM:  298 Our Network PROVIDES NATIONWIDE COVERAGE About Us
Offers a national network of more than  60,000 PHARMACIES,  including: CVS Pharmacy Walgreens Wal-Mart Rite Aid Target Kirby’s Family Pharmacy Healthcare Pharmacy The Pill Box Healthcare Pharmacy Kirby’s About Us
SUPERIOR MAIL ORDER SAVINGS (90-day supply) Brand:  AWP –  9%* Generic AWP – 40%* * Off Average Wholesale Price (AWP), less $3.50 administration & dispensing fee About Us
SUPERIOR RETAIL SAVINGS Brand:  AWP – 8%* Generic AWP – 35%* * Off Average Wholesale Price (AWP), less $3.50 administration & dispensing fee About Us
CLINICAL PHARMACY SUPPORT 50 years of professional clinical review experience  that helps reduce claim costs 24/7/365 pharmacy help desk Speak directly to physicians to encourage use of  generics and share information about new/less  expensive drugs and substitutes Clinical Aspects
OUR CLINICAL PHARMACISTS Review claims to identify those that can  benefit from more efficient/less expensive  drug combination therapies Review claims for utilization and drug history  to reduce incidents of drug interaction,  duplication, abuse and fraud Clinical Aspects
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Clinical Aspects
ENROLLMENT METHODS Daily data transfer of all new claims First Report of Injury from any direct reporting service,  processed via Electronic Data Interchange (EDI) Telephone contact, fax or email from adjuster KeyLink – our web-based claims management portal Information Technology
CLOSURE, PERSONNEL CHANGE  & FILE TRANSFER NOTIFICATION Daily data transfer Telephone contact, fax or email from adjuster KeyLink – our web-based claims management portal Information Technology
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Information Technology
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Information Technology

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Ks.luba.aug2010.final

  • 1. Your workers’ compensation pharmacy benefit manager About Us Clinical Aspects Information Technology
  • 2.
  • 3.
  • 4. About Us KeyScripts is a workers’ compensation PBM serving insurance carriers and self-insured employers in a market dominated by healthcare PBMs.
  • 5. BEST PRACTICES DEVELOPED THROUGH 30 years of workers’ compensation management and cost containment experience 50 years of clinical pharmacy experience About Us
  • 6. Offers savings through OUR WORKERS’ COMPENSATION FORMULARY Workers’ compensation driven Excludes unrelated healthcare drugs Reduces abuse, duplication and fraud About Us
  • 7. Offers savings through PRIOR AUTHORIZATION 1. FORMULARY-DRIVEN Drugs are tagged for authorization prior to fill, reducing costs associated with unrelated fills 2. ADJUSTER-DRIVEN Claimant-specific, as directed by the claims handler About Us
  • 8. GENERIC SUBSTITUTION Where available, and when brands are not physician-mandated or requested by claimant Achieved through KeyScripts WC Formulary About Us
  • 9. Optional FIRST FILL PROGRAM Temporary Prescription Benefit Cards distributed by employer when injury is reported Permanent cards then mailed to injured worker CARDS = COMPLIANCE = $$$ About Us
  • 10. REVERSAL PROCEDURES Typically, invoices can be reversed up to 7 DAYS AFTER FILL About Us
  • 11. REVERSAL PROCEDURES AFTER 7 DAYS Adjuster or repricer provides invoice to KeyScripts Pharmacy instructed to submit fills to KeyScripts Claimant reminded to take KeyScripts card to pharmacy About Us
  • 12. Client had a 47% penetration rate when KeyScripts assumed program management on 10/1/08 About Us
  • 13. SAMPLE STATE PENETRATION (No. of Pharmacies) LA: 1,061 MS: 808 AR: 731 TX: 4,182 OK: 875 NM: 298 Our Network PROVIDES NATIONWIDE COVERAGE About Us
  • 14. Offers a national network of more than 60,000 PHARMACIES, including: CVS Pharmacy Walgreens Wal-Mart Rite Aid Target Kirby’s Family Pharmacy Healthcare Pharmacy The Pill Box Healthcare Pharmacy Kirby’s About Us
  • 15. SUPERIOR MAIL ORDER SAVINGS (90-day supply) Brand: AWP – 9%* Generic AWP – 40%* * Off Average Wholesale Price (AWP), less $3.50 administration & dispensing fee About Us
  • 16. SUPERIOR RETAIL SAVINGS Brand: AWP – 8%* Generic AWP – 35%* * Off Average Wholesale Price (AWP), less $3.50 administration & dispensing fee About Us
  • 17. CLINICAL PHARMACY SUPPORT 50 years of professional clinical review experience that helps reduce claim costs 24/7/365 pharmacy help desk Speak directly to physicians to encourage use of generics and share information about new/less expensive drugs and substitutes Clinical Aspects
  • 18. OUR CLINICAL PHARMACISTS Review claims to identify those that can benefit from more efficient/less expensive drug combination therapies Review claims for utilization and drug history to reduce incidents of drug interaction, duplication, abuse and fraud Clinical Aspects
  • 19.
  • 20. ENROLLMENT METHODS Daily data transfer of all new claims First Report of Injury from any direct reporting service, processed via Electronic Data Interchange (EDI) Telephone contact, fax or email from adjuster KeyLink – our web-based claims management portal Information Technology
  • 21. CLOSURE, PERSONNEL CHANGE & FILE TRANSFER NOTIFICATION Daily data transfer Telephone contact, fax or email from adjuster KeyLink – our web-based claims management portal Information Technology
  • 22.
  • 23.