BWC's pharmacy benefits program covers outpatient medications prescribed to treat conditions related to an injured worker's state-fund, black lung and 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 and injured workers.
However, this program does not apply to self-insured claims. If you have questions related to a self-insured claim, 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) Price Inquiry
Workers’ compensation medication rules
- Payment for Outpatient Medication (OAC 4123-6-21) - contains rules for the outpatient medication program and applies to BWC state-fund, black lung and marine industrial fund claims.
- Payment for Outpatient Medication for Self-Insured Employers (OAC 4123-6-21.1) - contains rules used by self-insuring employers for their medication program for self-insured claims.
- Pharmacy & Therapeutics Committee (OAC 4123-6-21.2) - contains rules establishing the P&T Committee as a stand-alone committee.
- Outpatient Medication Formulary Rule (OAC 4123-6-21.3) - contains the rule establishing an outpatient medication formulary.