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Outpatient drug formulary

On Sept. 1, 2011, BWC implemented the outpatient medication formulary rule for the pharmacy program. The formulary appendix contains a list of drugs BWC will cover when prescribed for allowed conditions in an approved claim. The Pharmacy & Therapeutics Committee maintains the list, and regularly reviews and updates it.  Drugs not previously reviewed by the committee and listed in the formulary are not eligible for coverage by BWC. However, any BWC-certified physician can request the committee review a drug for addition to the formulary by submitting the Formulary Medication Request Form (MEDCO-35).
You may inquire about the outpatient medication formulary, prior authorization program, or other pharmacy-related matters by calling 1-877-543-6446 or emailing the pharmacy benefits department.
If you prefer, click on the link to download a copy of the complete formulary. Search for specific drugs by using the Ctrl+F function on your keyboard. Any restrictions or limitations on coverage are on the line beside the individual drugs. You can also utilize the drug look up tool but restrictions are only listed on the formulary appendix
The first fill drug list contains covered products to treat medical conditions identified in a pending workers' compensation claim. The first fill program is limited to the first fill of prescription drugs that occur prior to the date we issue an initial claim determination order.

Prior authorization

We require prior authorization for certain drugs not typically used to treat work-related injuries or illnesses based on the Federal Drug Administration's (FDA's) approved uses of that prescribed drug. The prescribing physician must complete the Request for Prior Authorization of Medication (MEDCO-31)  form to document clinical justification for the use of the prescribed drug(s) to treat the allowed condition(s) in an injured worker’s claim. Please include most recent office visit notes for supporting medical documentation.

Prior authorization is always required for:

•    All medications in medical-only claims beyond 60 days from the date of injury.
•    All medications beyond 270 days of last paid prescription.
•    All medications exceeding $3,000.

Note: Pending surgery, a physician can submit a MEDCO-31 to request pain medication or other post-surgically related medications after the MCO approval yet prior to the surgery date. The surgery date must be included on the MEDCO-31 for consideration. A medication request of this type is limited to a 30-day fill.