Pharmacy Benefits Manager (PBM)

The PBM is the vendor BWC has selected to process outpatient medication bills for state-fund, black lung and Marine Industrial Fund claims. Services provided by the PBM are separate from those handled by the managed care organizations (MCOs).

BWC designed the PBM program to reduce hassles for the injured worker and to streamline the billing process for pharmacy providers. The PBM frees pharmacists from completing and submitting paper bills, speeds the payment process and eliminates the guesswork on reimbursement amounts. At the point of service, the pharmacy provider receives notice about the claim's eligibility and whether or not BWC will reimburse the pharmacy for the submitted bill.

Other PBM services include enrolling pharmacy providers in a BWC-specific network, maintaining a prior authorization system for certain medications identified by BWC and utilization review editing for prescribed medications.

Note: Durable medical equipment and medical supplies purchased at a pharmacy are processed by the MCOs, not the PBM.

Click here for outpatient medication contacts.