The FECA drug formulary is a list of medications FECA claimants are eligible to receive. The FECA drug formulary is now currently active for all prescriptions.

Claimants and prescribers can access the FECA drug formulary by reviewing formulary documents or by checking prescription coverage on the claimant and prescriber portals. Quick reference guides are available for claimants on how to access formulary documents or check medication coverage after logging into the portal.

 

The FECA drug formulary is a list of medications FECA claimants are eligible to receive. The FECA drug formulary went into effect on December 9, 2021, for all new prescriptions. Non-formulary prescriptions for a medication taken in the six months prior to this date are considered legacy prescriptions. Per FECA Bulletin 22-02, all FECA claimants receiving legacy prescriptions are required to comply with the FECA drug formulary rules no later than December 9, 2022.

If a claimant’s prescription does not adhere to the drug formulary rules, the claimant must be transitioned to a prescription that does adhere to drug formulary rules. Prescribers may request an exception to the formulary rules by completing a non-formulary Prior Authorization Request Form (PARF) through the prescriber portal. If a legacy prescription is not changed to a medication on the FECA drug formulary, or the prescriber has not submitted a PARF, the legacy prescription will be denied at the pharmacy effective no later than December 9, 2022, unless there are extenuating circumstances. A claim for a legacy prescription may be denied prior to this date if a determination is made by OWCP that the medication is being prescribed to treat a condition other than the accepted condition, there is a severe new drug interaction, new safety alert, or if there is risk for fraud, waste, or abuse.

The FECA drug formulary does not cover brand-name medications where a generic is available. Thus, if a prescriber or claimant requests a brand-name medication where a generic is available, the brand-name medication will be rejected at the pharmacy. If a claimant is taking a brand-name medication, they must be transitioned to a generic alternative.

Throughout 2022, claimants and prescribers will be mailed notification letters if a claimant’s legacy prescription does not adhere to drug formulary rules. The letters will provide action steps to follow. These letters will also be available for viewing on the claimant and prescriber portals.

Claimants and prescribers can access the FECA drug formulary by reviewing formulary documents or by checking prescription coverage on the claimant and prescriber portals. Quick reference guides are available for claimants on how to access formulary documents or check medication coverage after logging into the portal using the links below.

Effective December 9, 2021, prescribers may access FECA’s new PBM Prescriber Portal by clicking on the prescriber portal link below (users will be redirected to OWCP Connect to verify their credentials prior to access). The PBM Prescriber Portal will give OWCP FECA registered providers with prescriptive authority, the ability to review a claimant’s medication and authorization history. Prescribers can also check on a drug’s coverage, review the formulary, utilization management edits, and submit prior authorization requests for drugs including opioids and non-formulary medications. Claimant’s last name, date of birth, and FECA case number will be required to access a specific claimant’s case.

Prescribers should be aware that FECA’s new prescription management policies include changes to opioid authorizations. The PBM will allow no more than one 7-day supply of an on-formulary, immediate release opioid prescription up to 90 morphine milligram equivalents (MME) per day for new opioid users with non-cancer pain, without prior authorization. Any subsequent fill beyond the initial 7-day supply will require prescribers complete a prior authorization request form located within the PBM Prescriber Portal. Prescribers should review FECA’s new prescription management policies here (https://www.dol.gov/agencies/owcp/FECA/regs/compliance/DFECfolio/FECABulletins/FY2020-2024#FECAB2202) detailing new prior authorization requirements.

FECA claimants should access the PBM Claimant Portal by first logging into The Employees’ Compensation Operations and Management Portal (ECOMP) available at https://www.ecomp.dol.gov/, then clicking on the pharmacy benefits management link on their case page to obtain more information about their pharmacy benefits. FECA claimants must be registered with ECOMP in order to access the PBM Claimant Portal. FECA claimants will be able to search for in-network pharmacies, and review their prescriptions. The PBM Claimant Portal link below will redirect claimants to ECOMP.

FECA claimants and prescribers may call 1-833-FECA-PBM (1-833-332-2726) for more information or if they have any questions.

In order to process prescriptions for DOL's FECA program, pharmacies MUST be part of the Optum/Tmesys Retail Network, process real time, and adjudicate electronically.  The FECA program stopped accepting batch pharmacy bills in December, 2017 as a step toward this point-of-sale requirement, and the new PBM is the final step. 

Effective 4/30/2021, you MUST submit all pharmacy bills point of sale, regardless of date of service, through the Optum network.  Thus, ALL pharmacy paper bills must be submitted before 4/30/2021.  As of 4/30/2021, DOL will no longer accept pharmacy paper bills for workers compensation medications covered under the OWCP FECA program. All medications must be processed at the point of sale with our PBM or home delivery program contractor, Optum Workers Compensation.

In February 2021, the U.S. Department of Labor (DOL) began the implementation of a new contract to provide Pharmacy Benefit Management (PBM) services to the Office of Workers' Compensation Programs' Federal Employees Program for claims covered under the Federal Employees' Compensation Act (FECA). DOL's new PBM contractor is PMSI, LLC d.b.a Optum Workers' Compensation Services of Florida ("Optum").

Optum/FECA pharmacy cards and welcome letters will be mailed to injured federal employees in a phased approach. Before April 1, 2021 welcome packets will be mailed to claimants who have been prescribed opioid medication(s) with daily dosages exceeding the 90 MED (Morphine Equivalent Dose) due to urgent safety concerns. Presently, these claimants receive pharmacy services through First Script/Coventry and will need to transition to Optum. Before April 30, 2021, welcome packets for all other FECA claimants will be mailed.

The use of the Optum/FECA pharmacy program is mandatory for ALL FECA claimants. Prescriptions will not be authorized at the pharmacy on or after the effective date printed on the recipient's card unless the card is presented at a participating pharmacy. If claimants have refills available at a non-participating pharmacy, an Optum/FECA network pharmacy may be able to transfer and receive the remaining refills.

Claimants can search for participating pharmacies through the above pharmacy locator icon or by contacting Optum at 1-833-FECA-PBM (1-833-332-2726). If a pharmacy provider would like to join Optum's network they should contact Optum at 1-855-264-8815 or email tmesys.network@optum.com.