myMatrixx  

Tampa,  FL 
United States
http://www.mymatrixx.com

• Booth: 851

myMatrixx® is a pharmacy benefit management company dedicated to workers’ compensation. The unique combination of myMatrixx and Express Scripts makes us the only workers’ compensation pharmacy benefit manager that can deliver high touch customer service, clinical expertise and actionable data analytics while leveraging Express Scripts’ pharmacy network, comprehensive clinical services, mail order program and specialty solutions to meet the individual needs of our clients and their injured workers. For more information, visit myMatrixx.com.

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 Press Releases

• Florida Rescinds Sub-Regulatory Policy on Physician Dispensing in Workers' Compensation (Aug 25, 2022)

  Last December, Phil Walls, our Chief Clinical Officer, along with multiple myMatrixx clients met with Mr. Andrew Sabolic of WCI and other representatives from the State of Florida Division of Workers’ Compensation (DWC). This meeting was part of a years-long effort to bring concerns of physician dispensing to the attention of the DWC, and the first result was delivered this July when the 2020 policy, which compelled reimbursements for physician dispensing, was finally rescinded.

  The state law establishes the injured worker has the right to choose a pharmacy of their choice.  It does not state that physicians that dispense drugs are considered pharmacists, which this bulletin implies. There is no free and absolute choice of doctor, nurse or practitioner in the statute.  The outstanding question is, since state law requires the injured worker be allowed pharmacy of choice, does that extend to prescribing physicians?   

  Florida Physician Dispensing Policy Update Overview

  

  Get the full myMatrixx letter below to learn how we were involved and what's next.DOWNLOAD

  In the 2022 Florida administrative hearing of Normandy Insurance Company vs. State of Florida, petitioners assert in an effort to keep cost reasonable, pharmacists and pharmacies must not be displaced from the system. These petitioners wanted this policy invalidated. 

  This policy stated carriers MUST authorize practitioner dispensing. Since failure to comply may trigger severe penalties, disagreements were likely. Although this bulletin was rescinded, current law still require payers to be responsive to prior authorization requests. 

  Read myMatrixx's overview detailing key takeaways of the discussion and opportunities for involvement when the Florida DWC holds a workshop in September, where they intend to draft proposed regulations within the scope of the law. We will remain engaged throughout the working group process to ensure that any proposed rules are appropriately within the scope of the statute.

  myMatrixx is dedicated to ensuring the best possible outcomes for our clients. If you have any questions or comments regarding this topic, please reach out. We will continue to keep you informed of the progress of these Florida rulings.

• myMatrixx Releases Demystifying Drug Pricing in Workers’ Compensation White Paper (Part One) (Aug 25, 2022)

  As rising drug prices continue to make headlines, there are certain conceptions about the pharmaceutical market that can benefit from clarification. When discussing the growing cost of drugs, we tend to frame the topic around name-brand versus generic drugs, with a view that despite the cost-saving opportunities of generics, overall spending on drugs continues to increase. In the workers’ compensation sector, data from myMatrixx supports this trend.

  

  Discover three market segments driving pharmaceutical spend and learn how to control claim costs.

  DOWNLOAD

  For years, we have seen generic utilization continue to increase among our clients, with 10% or more having a 100% substitution rate for medications where a generic equivalent is available. In 2020 alone, we saw overall generic utilization increase from 87% to 88.6% among our clients.

  If we look at the drug market purely through the traditional lens of brand versus generic, overall drug spending should be going down, both in the general health sector and in workers’ compensation. Explanations for why this is not the case, particularly from drug companies themselves, include the high costs of research and development and an increased focus on drug safety.

  However, segmenting the drug market into categories beyond purely brand versus generic drugs enables us to more accurately identify the major trends and drivers for drug prices in workers’ compensation. It is possible for drug spending to decline even when drug prices are increasing based on enhanced patient outcomes resulting from clinical pharmacy management and changes in claim counts and injury severity.

  In part one, we will provide an overview of three of the most important market segments driving pharmaceutical spending: the specialty drug market, compounding and physician dispensing. Coming soon for part two of this report, we will examine the overall pharmaceutical market looking at trends impacting price and utilization.

  These three categories are a major source of high drug spending, but they do not receive the same level of attention as traditional name-brand drugs. While most workers’ compensation payers may not experience all three of these trends in their pharmacy portfolio, any one of them can have a dramatic impact on overall spending even as claim counts decline. Understanding these segments and how to appropriately manage them should be a key component of any cost-savings strategy in today’s drug market.

  

• myMatrixx Releases Transforming Pharmacy Workflows with Automation & Decision Intelligence Trend Paper (Sep 08, 2022)

  Creating efficiencies in today’s workforce is more important than ever. Factoring in various world events – COVID, labor shortages, an aging population and a turbulent economy – companies, especially in workers’ comp, should be looking towards technology and innovation to assist in complex decision-making situations to free up time for more strategic patient outcomes. Not only does it affect the people in the field, but because it is a work-related role, claims professionals in workers’ comp often find themselves absorbing some of this chaos from the industries they are supporting.

  In a recently released paper, Cliff Belliveau (myMatrixx VP, Business Intelligence) and Hollie Lamboy (myMatrixx Sr. VP, Product Development) talk through automation and the power of data to streamline workflows and improve efficiencies for claims professionals. Key highlights include:

  • Automating the claims environment with decision intelligence
  • Building a more intelligent prior authorization process

  Download myMatrixx's new research paper and learn how Clinical and Business Intelligence solutions from myMatrixx can streamline your claims processing and strategy while promoting the safety and recovery of injured workers.

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