Zurich’s Narcotic Evaluation is a component of the Pharmacy Management program and is designed to address the growing concerns with narcotic use.
Claims submitted for review are assigned to a nurse case manager who reviews the file to identify potential mitigation opportunities. Each case reported to the program receives a case closure report showing the outcome and potential benefits of the referral.
There are three components to the program:
- Targeted letters (all narcotics) - Selected parameters with regard to narcotic utilization will trigger targeted letters to the medical provider(s) addressing the identified concerns and requesting specific responses.
- Benefits manager referral (Class II narcotics) - When the narcotic utilization escalates to hit identified triggers set forth by the narcotics program, Zurich’s pharmacy benefit manager will identify claimants for further review.
- Claim professional referral - Since each claimant may have different needs and circumstances surrounding their narcotic medication usage, Zurich claim professionals can also identify and refer claims to the program that originally did not meet the automatic referral criteria.
For cases requiring additional knowledge, a physician adviser may also be engaged.