New Pharmacy Benefit Manager for Workers’ Compensation Program

November 22, 2019

AWPRx will become MCIT’s new pharmacy benefit manager (PBM) Dec. 17. A PBM has been an integral part of MCIT’s workers’ compensation program since 2007.

The PBM program is a convenient way for injured employees to receive prescription benefits with no out-of-pocket expenses. Using the program also helps control workers’ compensation costs, which affects the cost of members’ workers’ compensation contributions.

Prior to Dec. 17, MCIT member employers will receive information about how the PBM works, including how to use first fill cards. The first fill card is provided to an injured employee at the time of the injury. An employee using this card can have medication prescribed for the work-related injury/illness filled at no cost—even before the compensability of the claim has been determined.

AWPRx has the ability to text or e-mail the injured employee the first fill information to ensure any prescription ordered until the permanent card arrives is processed at no cost.

Permanent PBM cards are mailed to an injured employee within 24 to 48 hours of confirmation by MCIT that the claim is eligible for the PBM. If MCIT determines that the claim is not eligible for the PBM, there is no cost to the injured employee or the employer. The permanent card is accompanied with instructions about how to use the card.

Choice of Mail or Store Fulfillment

Injured employees can choose to receive prescriptions necessary to treat their work-related injury/illness using a mail order service. Once enrolled in the mail order service, medications are shipped to the employee’s home via the U.S. postal service free of charge within two to eight business days from the date of the employee’s enrollment.

Employees needing prescriptions are still able to purchase medications at any pharmacy of their choosing. AWPRx has a national pharmacy network comprised of more than 70,000 pharmacies. The network includes all major pharmacy chains and the vast majority of local independents.

Transition to AWPRx

Injured employees using MCIT’s current PBM, MyMatrix, will receive a packet from AWPRx along with a new PBM card. A representative of AWPRx will contact these employees via phone to verify receipt of the card and how best to utilize the PBM.

MyMatrix cards can be used until Jan. 1 when all injured employees using the PBM program must use the AWPRx card.

To assist MCIT member employers and injured employees with questions, AWPRx has customer service representatives available to take phone calls. Turnaround time for inquiries from employees are given the highest priority and are typically resolved within minutes.

In 2020, MCIT will be enhancing the claims reporting process to provide the first fill information at the same time the first report of injury is returned to the employer. Members should stay tuned for more information about this enhanced feature.