Pharmacy Benefit Management

Our Pharmacy Benefit Management program is uniquely positioned in its collaboration and integration within BMMS. We do not operate in a silo; we work directly with the medical review process and case management teams.

• Integrated Claim Data Review: Our pharmacy program is able to look at the claim data as it happens, allowing us to see medical records and apply medical review to make informed decisions on medication. This integration provides for better injured worker safety and a faster return to work.
• Safety and Appropriateness: We provide continuous oversight and real-time claim reviews to monitor interactions between workers compensation medications and non-workers compensation medications safely and appropriately.
• Claim Cost Control: By providing analysis of out-of-network spend and offering insight into claims trends, we help keep costs down and provide essential education to adjusters.

Our advantages provide a comprehensive, cost-effective, and safe solution for managing pharmacy benefits:

• Cost Advantage: We consolidate the purchasing power of various smaller entities to achieve lower pricing, providing a significant financial advantage.
• Oversight & Expertise: In collaboration with a national Pharmacy Benefit Management program, we have access to claims systems and medical records that allows us to know if an injured worker is taking medication that conflicts with their ability to work (e.g., operating heavy machinery). This provides jurisdictional knowledge and clinical expertise other PBMs may not possess.
• Communication & Support: For questions and assistance, the BMMS Assist email address is the keeper of all issues.

Resources Available via BMMS Assist

Through BMMS Assist, employees have access to helpful resources and guidance as it relates to Pharmacy Benefits including:

• Instructions for how to get your First Fill Card (temporary pharmacy card).
• Information on your Permanent Pharmacy Card.
• Answers to questions on prescriptions and pharmacy contact information.
• Guidance on communicating with providers.
• Information regarding the review of medical bills received.

Have questions or need support? Contact the BMMS Assist team by email for personalized assistance.