In February 2021, the U.S. Department of Labor (DOL) began implementation of a new contract to provide Pharmacy Benefit Management (PBM) services to the Federal Employees’ Compensation Act (FECA) Program for all claims covered under FECA. DOL’s new PBM Contractor is PMSI, LLC d.b.a Optum Workers’ Compensation Services of Florida (“Optum”). The FECA Program’s PBM will be responsible for pharmaceutical transactions including but not limited to implementation of FECA Program eligibility determinations and pricing for pharmaceutical drugs provided to FECA claimants.
The approximately 4,200 claimants receiving 90 MED (Morphine Equivalent Dosage) or higher of prescribed opioids who are receiving services under an earlier limited PBM with Coventry/First Scripts will be transferred to the Optum PBM effective April 1, 2021. With the implementation of this contract, the FECA PBM will be expanded to the remainder of our FECA claimant population by May of 2021. The two phases for card distribution are as follows:
PHASE 1: Welcome packets and new, Optum pharmacy cards will first be mailed to the 4,200 claimants receiving 90 MED or higher. Those PBM cards will become effective on April 1, 2021. Those cards will bear the effective date in the center of the pharmacy card between the Optum and DOL seals, as depicted in the sample pharmacy card below:
PHASE 2: Welcome packets and new, Optum pharmacy cards will then be mailed to the remaining 200,000 claimants (approximation of numbers). Those PBM cards will become effective on April 30, 2021. Those cards will bear the effective date in the center of the pharmacy card between the Optum and DOL seals, as depicted in the sample pharmacy card below:
Prescriptions will not be authorized at the pharmacy on or after the effective date printed on the recipient's card unless the Optum card that looks like the samples above is presented at a participating pharmacy. If claimants have refills available at a non-participating pharmacy, an Optum/FECA participating pharmacy may be able to transfer and receive the remaining refills. Claimants can search for participating pharmacies on the web (ecomp.dol.gov) or by contacting Optum at 1-833-FECA-PBM (1-833-332-2726). Use of the Optum/FECA pharmacy program is mandatory for all FECA claimants.
For additional information please see FECA Bulletin 21-07 “New FECA Pharmacy Benefits Management System”