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Division of Coal Mine Workers' Compensation (DCMWC)

Changes in Pharmacy Reimbursements (February 2009)

The Federal Black Lung Program (FBLP) has recently made three changes in the way pharmacies are reimbursed for prescriptions covered by the Federal Black Lung Program.  These changes apply to both point-of-sale and paper billing.

The dispensing fee is now set at a flat rate of $4.00 per prescription, a change from the previous fee that ranged from $2.50 to $10.00.

The reimbursement rate is now set at 95% of the average wholesale price (AWP) of the covered drug, a reduction from the previous rate of 100%. 

Reimbursement is now set at the generic drug rate unless the physician specifies Dispense As Written (DAW) on the prescription.  All claims will edit to have the DAW field reviewed in the claim process. All claims will also process for payment if:

DAW = 1* brand name selected when requested by physician.

DAW = 8* brand dispensed because the generic is not available from the manufacturer.

DAW = 0* brand drug selected with no generic available on the market.

Generic drugs will be selected automatically when the brand name is also available.

The FBLP will not be using any other DAW codes.

If you have any questions, you may contact DCMWC at DCMWC-Public@dol.gov.