According to a new Coventry whitepaper, engaging a pharmacy nurse as soon as potential risks are identified is the most proactive approach to patient education and safety.
Pharmacy nurses are specially trained case managers who focus on at-risk claims due to emerging and complex pharmacy utilization, and communicate with prescribing physicians, injured workers, and claims handlers to positively impact drug utilization.
By using a wider lens to manage all aspects of the claim, these nurses:
— Ensure patient engagement, safety, and education.
— Confirm pharmacy utilization is medically appropriate and supports a timely recovery.
— Enable timely medical stability and return-to-work.
— Consult with case managers when complex pharmacy issues are identified on open claims.
— Provide consultation to claims handlers on pharmacy questions and issues.
— Review monthly pharmacy trend reports.
— Collaborate with clinical pharmacists on alternative medications.
— Utilize drug utilization assessment (DUA) to assist in provider discussions.
A pharmacy nurse can work quickly to identify concerning medications to reduce the likelihood of addiction. During early narcotic intervention, pharmacy nurses can call the prescriber to discuss alternative treatment plans to influence future prescribing habits and decrease narcotic utilization.
From first opioid utilization through discontinuation, a pharmacy nurse can support patients at each step of therapy, advocating for the safe and effective discontinuation of opioids for injured workers.
For employers dealing with existing claims, pharmacy nurses can also step in and make significant impacts on older claims with sizeable pharmacy utilization. The nurse reviews the pharmacy history and collaborates with the pharmacy benefit manager (PBM), provider, and injured worker to identify opportunities to reduce overall drug utilization while improving patient safety.