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Pharmacy benefits program

BWCs pharmacy benefits program covers outpatient medications prescribed to treat conditions related to an injured workers state-fund, black lung and Marine Industrial Fund claim. Under BWCs 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 for assistance.

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.
Drug formulary