Question: What is a PBM?
Answer: Northwood is a Pharmacy Benefit Manager (PBM) that is working with auto no-fault and workers’ compensation clients to administer pharmacy network management, drug utilization review, and outcome management. The PBM program allows network pharmacies to bill electronically versus submitting paper claims.
Question: What is a DBM?
Answer: Northwood has modeled its durable medical equipment, prosthetics, orthotics and medical supply (DMEPOS) administration after the strengths of the PBM strategy. Similar to what a PBM does for managing pharmacy benefits, Northwood does for the management of DMEPOS benefits. Northwood’s Durable Medical Equipment Benefits Management (DBM) model creates a transparent program that enhances the value of DMEPOS benefits, while reducing overall costs and improving patient care.
Question: Who is eligible for the PBM and DBM program?
Answer: Insureds/claimants entitled to auto no-fault or workers’ compensation benefits whose injury-related medical condition requires over-the-counter, prescription medications and DMEPOS services are eligible for the PBM and DBM program.
Question: Will the insured have to pay out-of-pocket expenses?
Answer: No, insureds/claimants entitled to auto no-fault or workers’ compensation benefits will not have to pay out-of-pocket for pre-authorized injury-related over-the-counter and prescription medications.
Question: What should I tell the claimant about the Northwood PBM program?
Answer: The following Claim Staff Script has been developed to assist you with explaining the PBM program:
As part of “clients” continuing efforts to maintain the highest level of quality service to “clients” insureds/claimants entitled to auto no-fault (or workers’ compensation) benefits, “client” is working with Northwood for its Pharmacy Benefit Management (PBM) and Durable Medical Equipment Benefit Management (DBM) services. The benefit of this pharmacy program enables our claimant entitled to auto no-fault (or workers’ compensation) benefits to go to a network pharmacy of their choice and there are no out-of pocket expenses.
“Client” requires medications be pre-authorized for injury relatedness. Your physician or pharmacist can call Northwood at 1-877-684-9276 to make the referral.
Question: Will this program extend to pharmacies, DMEPOS providers outside of Michigan?
Answer: Yes, Northwood’s network includes over 54,000 pharmacies and approximately 5,800 DMPEOS providers nationally. A claimant can obtain a pre-authorized injury-related over-the-counter, prescription medication, DMEPOS services from out-of-state network providers.
Question: How do I refer new insureds/claimants, add services to current insureds/claimants or contact Northwood for assistance after normal business hours?
Answer: Northwood’s regular operating hours are Monday-Friday from 8:30 a.m. to 5:00 p.m. EST.
Question: How do I refer a claimant to the Northwood DBM/PBM program?
Answer: The following steps have been developed to assist you with the referral process:
STEPS TO PLACE AN ORDER FOR PHARMACY SERVICES: