OWCP has implementation of a Pharmacy Benefits Management (PBM) System by the Office of Workers' Compensation's (OWCP) Division of Federal Employees' Programs. Pharmacy benefit managers are third-party administrators (TPA) of prescription drug programs for commercial health plans, self-insured employer plans, Federal and State government employee health plans. PBMs are primarily responsible for developing and maintaining formularies which include an approved listing of prescriptions, contracting with pharmacies to increase enrollment, negotiating discounts and rebates with drug manufacturers and processing and paying prescription drug claims.. OWCP’s FECA PBM will be responsible for pharmaceutical transactions including implementation of FECA eligibility determinations and pricing for pharmaceutical drugs provided to FECA claimants. All FECA claimants will be required to use the OWCP FECA PBM for prescribed drugs; otherwise, payment of drugs will not be authorized at the pharmacy. The PBM will pay network pharmacies directly and then seek reimbursement for those payments from FECA’s Employees’ Compensation Fund.

In order to receive pharmacy benefits, injured workers must present their new pharmacy cards to a participating pharmacy along with prescriptions for their accepted, work-related condition(s). Optum/FECA pharmacy cards and welcome letters will be mailed to current FECA claimants in multiple groupings. Due to urgent safety concerns, welcome packets will first be mailed by April 1, 2021, to claimants who have been prescribed opioids with daily dosages exceeding the 90 MED (Morphine Equivalent Dose). Pharmacy Cards and welcome letters for the remainder of the FECA claimants will first be mailed by April 30, 2021. All Pharmacy cards will include a Bank Identification Number (BIN), the date the cards become effective, a PBM toll-free number for information, as well as claimant-specific information. Once the FECA PBM is phased in, use of an employing agency pharmacy (PBM) program is no longer permissible.