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Eliminate PBMs From Your Worker’s Compensation Claims AND Keep More Profits By Billing Direct

Don’t let the PBMs keep your hard earned profit dollars!

StreamCare is an industry partner of PDS that helps members bill direct for their worker’s compensation prescriptions and eliminate the costly PBM middleman. Through StreamCare, worker’s comp prescriptions are still easy to process and will yield a much higher profit for the pharmacy. Get your maximum reimbursement possible by billing direct for your work comp patients.

StreamCare has made brand names more profitable by cutting their rate significantly to allow you to realize a larger profit for brand name medications. The exact rate depends on your state, for specific information on your state’s rate fill out the form on this page to receive information directly from PDS’ partner StreamCare.

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How Will StreamCare Impact My Pharmacy?

Most states have very generous reimbursement schedule rates for work comp prescriptions. The problem is when you bill through a typical PBM or processor such as Express Scripts or Tmesys, you are agreeing to their rate schedule and letting them keep the difference. This difference is often very significant and while you are doing all of the work, they are keeping your profits. StreamCare can help you bypass the PBM and bill direct to your state’s work comp carrier, thereby you get to keep more of your profit.

Consider the potential impact on your profitability using the example numbers below. Let’s say that…

ACME PBM’s contract is currently at AWP -82% for generic reimbursements.

While your state will pay full AWP for the same generic.

StreamCare charges a 30% fee for generics and lower for brands from what is collected only

A $10 dollar reimbursement becomes a $190 just by using StreamCare

Potential Profits You Can Earn By Eliminating The PBM For Work Comp Claims

MEDICATIONFROM (WITH PBM)TO (WITH STREAMCARE)
Tizanidine 4mg #90$8.57$95.24
Gabapentin 800mg #90$10.42$194.09
Duloxetine 60mg #30$10.04$161.29
Meloxicam 15mg #30$5.00$92.36

Over $500 in extra profit for filling the exact same prescriptions and the carrier is paying the exact same amount. Learn the specific states this method will work in and how to get started by filling out the form. Questions? Call StreamCare at (904) 323-2273.

Do you feel like it is too good to be true?

While it does seem like magic or somehow gaming the system, nothing could be further from the truth. Each state has a reimbursement schedule they are willing to pay for work comp prescriptions. Surprise! Many are at full AWP. Could you imagine getting paid full AWP for a generic? Sadly, most pharmacies never see that full reimbursement as PBMs take 95% of the claim and the pharmacy just sees the left over pennies.

1. The work comp carrier will not pay out any more money by using the StreamCare method.
2. This method will not work in all 50 states.
3. StreamCare charges 30% of what is collected for generic claims and even less for brand name claims. They only get paid if you get paid.

Wondering how it all works and if billing is difficult?

The hard work of billing direct is really done on the backend through StreamCare. For a pharmacy billing to StreamCare is similar to billing a regular claim. You will need to gather some extra information since it is due to an injury. Items such as date of injury and the employer information. Once you bill to StreamCare, they receive the claim and get to work on manually billing to the proper insurer. Watch a brief 9 minute video on how to bill a claim to StreamCare.

Imagine an area of your business that you could freely grow without the negative influence of PBMs!

As a PDS Member, you have exclusive access to StreamCare’s lowest fee schedule in order to maximize the profits you can get from your work comp prescription business. Fill out the form at the top of this page so StreamCare can contact you to get all of your specific questions answered.

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Not a PDS Member? Talk to one of our pharmacy experts today. Fill out the form below and someone will be in touch within one business day.