Why is distributing benefits to workers comp benefits so much more difficult and expensive than in group health?
Daryl Corr: It’s a totally different animal between group health and workers’ comp. In comp, when the patient shows up at the pharmacy counter, the pharmacist has to deal with a lot of unknown items that can cause delays or problems with filling the prescription. Compared with group health, over 90 percent of the time, it’s easy because there isn’t any sort of prior authorization required to complete the transaction and bill the appropriate party. With an injured worker, they may not have even reported the claim before they submit the prescription. There isn’t any prior information available, and the pharmacist has to figure out whom to bill, which immediately creates an eligibility issue. From the injured worker’s perspective, comp is 100 percent paid by the carrier (payer), and without any co-pay, they don’t have a vested interest in the payment outcome. So the easiest thing for the pharmacist to do is to send it to a contracted third-party biller. You are also dealing with a differe
