Medical Programs - ESIS Impact

Pharmacy Benefit Management (PBM)

Using data analytics and predictive modeling to identify and manage pharmacy costs.

ESIS PBM combines strong oversight and technology interfaces to ensure the right drugs, dosages, and durations are implemented to help save money and improve medical outcomes.

Key pharmacy solutions include:

  • Customized formularies — triggered by injury code from the claim
  • Clinical letter programs — ensure appropriate medication therapy
  • First fill — enrolled employers are able to provide injured workers with immediate pharmacy information to avoid out-of-pocket expenses
  • Clinical triggers — ESIS Triage nurse reviews specific pharmacy triggers, working with the claims representative on next steps
  • Pharmacy Utilization Review (PUR) — provides recommendations for medication therapy and incorporates embedded case management, resulting in streamlined and optimized care
  • Compound medications — ESIS Pharmacy Impact’s clinical team identifies all compounds at the point of sale and works with the pharmacy for acceptable alternatives
  • Pain management — our predictive risk scoring model identifies high risk claims for our clinical team to review in order to utilize tools, such as urine drug monitoring, to help prevent a chronic pain claim from developing
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