Does Workers’ Compensation Pay for Prescriptions?

workers' compensation prescriptions

Workers’ compensation laws vary from state to state.   However, all state workers’ compensation laws provide for payment of prescriptions in some form or another. Read on and contact AllianceMeds today to learn more.

The workers’ compensation insurance carrier is usually responsible for payment of “reasonable and necessary” prescription medications that are related to the accepted work injury.   A common example would be if an injured worker has a back injury and the treating doctor prescribes a Lidocaine patch for pain relief.

Issues may arise when the prescribed medication does not directly relate to the accepted injury even though the medication is needed to treat the work injury.   For example, pain from the low back injury keeps the injured worker awake at night and the treating doctor prescribes Ambien as a sleep aid.   In these situations, AllianceMeds will work with your doctor to obtain proof of the medication’s relation to the work injury and continue to fill your medication while we ultimately resolve the payment of the medication with the insurance company.

What limits are placed on the Workers’ Compensation Insurance Company’s obligation to pay for my prescription medications?

Some states have adopted a drug formulary that limits which medications a workers’ compensation insurance carrier must pay for.   It is important in these situations to have your doctor prescribe a medication on the formulary, otherwise, the insurance company may legally deny payment.

In addition, some states limit the injured workers’ choice of a medical provider.   In these states, the insurance company is allowed to force the injured worker to use their pharmacy. Fortunately, Pennsylvania, Maryland, New Hampshire, Virginia and many other states allow injured workers to choose their own pharmacy.    Sometimes the insurance company will still attempt to bully the injured worker into using their pharmacy even when the law states that the injured worker has the right to choose the pharmacy.

Why does the Insurance Company want to choose my pharmacy?

The insurance company often tries to force the injured worker to use a pharmacy they choose in order to control the injured worker’s medical treatment and ultimately limit costs.   Insurance Companies are able to put a red flag in the electronic file used by most local and chain pharmacies stating what medications they will deny.   The denial may not be lawful.   However, many local and chain pharmacies will refuse to fill the medication when prompt payment is not guaranteed.   As a result, the injured worker is forced to pay out-of-pocket or accept a different medication altogether that was not his/her doctor’s first, or maybe even second or third choice of treatment.  The insurance company is often motivated by cost savings rather than ensuring the best course of treatment is received.

I have an open workers’ compensation case and I know my medication is work-related so why did my local pharmacy tell me my prescriptions were denied? 

Sometimes the insurance company tells the local and chain pharmacies that payment is denied even when they have no lawful reason to do so.   The insurance company hopes that denials will force injured workers to use pharmacies chosen by the insurance company as discussed above.   They also hope that the injured worker may agree to a cheaper substitute or pay out-of-pocket rather than continue to deal with the ongoing hassles.   Finally, the insurance company may try to make your case as difficult as possible to wear your down in the hopes you will accept a lower settlement.

Should I allow my personal insurance to pay for my workers’ compensation prescriptions? 

Your local or chain pharmacy may attempt to bill your personal insurance if the workers’ compensation insurance carrier denies payment of your bills.    This may cause a lien issue that needs to be paid at settlement.   It is always best to bill the workers’ compensation insurance carrier for all medications needed to treat your work injury.

I need my medications.   What do I do if they are denied? 

AllianceMeds levels the playing field and lets you stand up to the insurance companies’ unfair tactics.  We understand how overwhelming workers’ compensation laws can be and are here to help you.   Our goal is to make sure you receive the medications – as prescribed by your doctor.  AllianceMeds delivers your medications in secure packaging right to your front door.    We always fill medications on time, even if payment is denied or your case is in litigation.   We have the expertise to resolve many payment issues on our own and will work with your attorney if your case is in litigation.   AllianceMeds bills the insurance carrier directly.   There is no fee to you, your attorney or your doctor.  If you have any questions about how we can help, contact AllianceMeds today.