Specifications include, but are not limited to: BWC’s PBM is responsible for maintaining a pharmacy claims system to allow pharmacies to bill medications for injured workers at the point of sale. The PBM must validate specific information provided by BWC as bills adjudicate. BWC provides information related to eligibility, overrides, and restrictions. BWC’s pharmacy department processes all manual prior authorizations. Our dedicated pharmacy call center handles customer service inquiries via phone and email. The PBM is expected to operate a call center to provide technical billing assistance. The Contractor, at a minimum, shall provide the following services: 1. Pharmacy bill adjudication according to BWC’s closed formulary 2. Pharmacy provider network contracting, auditing, and maintenance 3. Pharmacy provider bill submission technical call center 4. Maximum Allowable Cost (MAC) pricing management 5. Transparent, pass-through pricing to pharmacies 6. Reporting, including standard and ad-hoc capabilities, to manage pharmacy program services effectively and efficiently 7. Comprehensive rebate management for all covered outpatient drugs including rebate negotiation, collection, detaillevel reporting, and transparent pass-through payments to BWC OBJECTIVES. DAS has the following objectives that it wants this Work to fulfill, and it will be the Contractor’s obligation to ensure that the personnel the Contractor provides are qualified to perform their portions of the Work. 1. Provide quality pharmacy services to Ohio’s injured workers. 2. Provide BWC’s injured workers access to network pharmacies, including pharmacies outside of Ohio. 3. Provide BWC staff access to prescription drug data using a real-time bill processing system. 4. Manage drug information efficiently and provide BWC with accurate and timely information. 5. Ensure correct payment of injured worker pharmacy benefits based on the eligibility data received from BWC. 6. Pay pharmacies promptly following BWC’s funding of approved bills. 7. Collect all rebates available on paid pharmacy bills.
