Progressive Medical, StoneRiver Pharmacy Solutions Partnership Enables Companies to Reduce Out-of-Network Pharmacy Expenses

WESTERVILLE, Ohio--(BUSINESS WIRE)-- Progressive Medical, (http://www.progressive-medical.com) the leading out-of-network pharmacy solution provider, and StoneRiver Pharmacy Solutions (http://www.stoneriver.com/solutions/stoneriver-pharmacy-solutions), announced today they have deployed a state-of-the-art solution that enables carriers and employers to gain financial and clinical control of workers’ compensation prescriptions that are submitted online without a medication card.

StoneRiver Pharmacy Solutions and Progressive Medical leverage real-time connectivity between the two organizations to provide this unique solution. When pharmacies are unable to identify the appropriate payor, they submit prescriptions associated with Progressive Medical clients’ workers’ compensation prescription claims to StoneRiver Pharmacy Solutions. StoneRiver Pharmacy Solutions transmits an immediate, real-time alert to Progressive Medical, which then reviews the prescriptions for eligibility and applies drug utilization review edits. Progressive Medical returns their results to StoneRiver Pharmacy Solutions, which in turn completes the adjudication and transmits the response to the pharmacy.

This innovative partnership is expected to yield significant cost savings for workers’ compensation claims administered by Progressive Medical clients by dramatically reducing the number of unmanaged out-of-network prescriptions.

Texas Association of School Boards Risk Management Fund (Fund) is one such client to realize cost savings through this solution. “Each year, the Fund handles a significant number of workers’ compensation claims,” said Herman Wilks, Department Director of Workers’ Compensation Claims, Texas Association of School Boards. “Pharmacy expenses account for a significant portion of the medical costs on these claims. We have demonstrated that this partnership enables the Fund to dramatically reduce pharmacy costs by streamlining adjudication of what would traditionally have been out-of-network invoices.”

Due to the high volume of workers’ compensation claims handled by companies each year, manually processing paper invoices is quite costly. Perhaps more importantly, paper invoices are not subject to payors’ real-time drug utilization review or formulary edits. Through the StoneRiver Pharmacy Solutions–Progressive Medical solution, the majority of paper invoices can now be processed electronically and edits applied in real-time, greatly streamlining the entire process and ensuring appropriate pharmaceutical utilization.

“Progressive Medical continually seeks new ways to help its clients contain costs,” said Tron Emptage, Chief Clinical and Compliance Officer for Progressive Medical. “StoneRiver Pharmacy Solutions was the ideal partner for this program because of their unique relationship with pharmacies and their willingness and ability to co-develop this unique technology to bring about greater efficiency and cost savings. This program will allow us to dramatically reduce out-of-network pharmacy expenses for our clients that choose this program.”

Emptage also added that this process is already being enhanced to better allow for proper alignment and processing of injured parties to their payor and their payors’ programs. This electronic interface will enable Progressive Medical to run all out-of-network pharmacy expenses through its drug utilization review program, helping to reduce risk as well as assisting in eliminating inefficiencies and inappropriate utilization in the system.

“StoneRiver Pharmacy Solutions is proud to partner with Progressive Medical on this important initiative,” said Emry Sisson COO of StoneRiver Pharmacy Solutions. “This initiative eliminates operational burden for our pharmacy clients while enabling Progressive Medical to demonstrate greater efficiencies by significantly streamlining the out-of-network adjudication process. By leveraging our technology and pharmacy relationships, we are able to help Progressive Medical achieve its objective of reducing loss costs for their clients without impacting our pharmacy clients.”

About StoneRiver Pharmacy Solutions
StoneRiver Pharmacy Solutions provides workers’ compensation prescription billing solutions to more than 55,000 pharmacies nationwide. In addition, StoneRiver Pharmacy Solutions also provides employers and payors with comprehensive cost management solutions. StoneRiver Pharmacy Solutions combined with StoneRiver P2P Link, a transaction hub linking payors and medical provides innovative solutions for injured workers, employers, pharmacies and payors. Visit http://www.stoneriver.com for additional information.

About Progressive Medical, Inc.
Progressive Medical (http://www.progressive-medical.com), through a national network, offers cost management services and products to the workers’ compensation and auto no-fault insurance industries. Progressive Medical has invested more than 20 years of experience in developing innovative pharmacy management and ancillary solutions for its clients. By combining its clinical expertise with access to an expansive network of pharmacies, home health care services and medical equipment, Progressive Medical enables its clients to manage costs while providing quality care to injured parties.

Learn more at http://www.progressive-medical.com or by calling 800.777.3574.