Guest Article: Reducing the Cost of Prescription Medications in Workers' Compensation Cases and MSAs


This article was recently written by Jeff Carlisle of Carlisle & Associates. In light of our upcoming webinar focusing on how to reduce the cost of prescriptions during the life of a workers' compensation claim as well as when settling cases with a Medicare Set-aside, we wanted to share it with you.


Prescription drug costs comprise a substantial portion of medical expenditures for workers compensation claims, representing approximately 14% of ultimate total medical costs based on recent research performed by NCCI. Medicare Set-Asides (MSA) represent more than 40% of the total submitted workers compensation settlement costs. Working with an attorney and clinical review company has the potential to provide significant savings. A Case Management Prescription Review, in conjunction with a case manager and physician consult, has shown to be effective 85% of the time in reducing medication expenses.


Clinical Review companies, such as Carlisle Medical, perform Case Management Prescription Reviews. These comprehensive clinical reviews are performed by a pharmacist (PharmD) and a registered nurse, with the goal of achieving maximum savings by providing cost-effective drug therapy recommendations. Case Management Prescription Reviews contribute to lowering MSA allocations, as well as lowering reserves and overall settlement values.


The Case Management Prescription Review service includes a document signed by a clinical pharmacist outlining the potential alternatives and other cost drivers. Examples include the following:

  • Brand drugs with generic equivalents

  • Therapeutic Equivalents

  • Opioid Weaning intervention

  • Drug Manufacturer Guidelines

  • Injury Relatedness

  • Duplicate Therapy

Once the review has been completed, a field case manager is assigned the task of meeting with the authorized physician to discuss cost-effective alternatives. Prescription drug costs will likely continue to escalate for the foreseeable future. It is possible to reduce these costs with assistance from an MSA provider and a Clinical Review Company. We would like for you to join us for a free webinar on July 15th to learn more about this exciting program. Valuable continuing education credits will be provided. To register, click HERE.

Case Study: A SINGLE prescription review saved a client $1.7 million


Carlisle Medical was contacted to review a case submitted for an MSA settlement. A 62-year-old patient had hurt his back in a work-related injury. Over the years, he had also hurt his foot, which was not a work-related injury. Although the two injuries were not related, the patient’s doctor was providing care for both injuries. Both injuries utilized the same medication types for treatment, resulting in the continued payment of medications unknowingly. Carlisle Medical immediately scheduled a consult with the physician to communicate the findings. During the nurse’s consult with the physician, it was determined that a number of the medications for which the insurance company was paying were unrelated to the injury. *This is an actual case and numerous others have been documented. Savings rates vary, depending on specifics of the claim. For more information contact Jeff Carlisle at 251-344-7988 or visit www.carlislemedical.com.

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