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),
OptumRx. As soon as an injury occurs, even before BWC assigns a claim number
the pharmacist can submit a drug bill to BWC.
To learn more, click on one of the topics listed below.
Note: 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
Outpatient medication formulary
Effective 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.
Note: 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).
We've also allowed for non-formulary drugs to be covered for up to 180 days in cases of true medical
necessity where there is no other drug available to treat the allowed condition.
Click on the link below to download a copy of the formulary. You may 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 of the drug.