On Sept. 1, 2011, BWC implemented the outpatient medication formulary rule for the pharmacy program. The formulary contains a list of drugs that 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 physician can request the committee to review a drug for addition to the formulary. Use the Formulary Medication Request Form (MEDCO-35).
Send questions or comments about the outpatient medication formulary, the outpatient medication prior authorization program or other related matters by calling 1-877-543-6446 or emailing the pharmacy benefits department.
The Drug formulary look-up is a tool to look up coverage for a specific drug. Enter a partial or complete drug name, and then click search.
If you prefer, click on the link below to download a copy of the complete formulary. Search for specific drugs by using the Ctrl+F function on your keyboard. On the line beside the individual drugs, you'll see any restrictions or limitations on coverage.
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 BWC issues an initial claim determination order.
BWC requires prior authorization for certain drugs not typically used to treat work-related injuries or illnesses when a condition is not allowed in the claim that supports 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) to document the relationship between the prescribed drug(s) and the allowed condition(s) in an injured worker’s claim.
BWC requires prior authorization for all medications in medical-only claims beyond 60 days from the date of injury and for all claims beyond 270 days of last paid prescription. Pending surgery, a physician can submit a MEDCO-31 to request pain medication or other post-surgically related medications subsequent to the MCO approval yet prior to the surgery date. The surgery date must be included on the MEDCO-31 for consideration. A mediation request of this type would be limited to a 30-day fill.