Pharmacy Benefits
BWC's pharmacy benefits program covers outpatient medications prescribed to treat conditions related to an injured worker's state-fund, black lung, or Marine Industrial Fund claim. Under BWC's program, pharmacists can submit most drug bills directly to BWC at the point of service through BWC's pharmacy benefit manager (PBM) vendor, Change Healthcare.
As soon as an injury occurs, even before BWC assigns a claim number, the pharmacist can submit a bill using the first fill instructions in the link below. Pharmacies submit bills for prescriptions electronically to the PBM. The PBM has access to BWC claim information and approves or denies bills accordingly. The PBM issues payment for prescriptions directly to pharmacy providers.
This program does not apply to self-insuring employers. If you have questions related to claims with a self-insuring employer, please contact the employer, or call 1-800-644-6292 for assistance.
To learn more, click on one of the topics listed below.
- Outpatient drug formulary
- Opioid prescribing rule and guidelines
- Billing and first fill program
- Pharmacy and therapeutics committee
- Maximum Allowable Cost (MAC) Adjustment Form
- Contacts
Workers’ compensation medication rules
- Payment for Outpatient Medication (OAC 4123-6-21) - establishes the outpatient medication program applying to state-funded, black lung, and marine industrial fund workers compensation claims.
- Payment for Outpatient Medication for Self-Insuring Employers (OAC 4123-6-21.1) – establishes the outpatient medication program applying to self-insuring employers’ workers compensation claims.
- Pharmacy & Therapeutics Committee (OAC 4123-6-21.2) - establishes BWC’s Pharmacy & Therapeutics (P&T) Committee and its rules and responsibilities.
- Outpatient Medication Formulary Rule (OAC 4123-6-21.3) – establishes the outpatient medication formulary and links to the formulary appendix.