Workers' Compensation: Prescription Drug Facts

Posted By Katz Leidman Grossman Wolfe & Freund || 8-Jun-2015

Workers' compensation is a no-fault system which enables injured workers to receive the medical aid and pharmaceutical services needed to return to work at the appropriate time considering their injuries and disabilities.

According to the Express Scripts 2014 Workers' Compensation Drug Trend Report, pharmacy costs accounted for 18% of the total spent on workers' compensation. With that in mind, injured workers' employers and carriers are continuously looking for ways to cover the costs of prescriptions in a cost-effective manner.

Frequently Asked Questions

Here are some frequently asked questions about prescription drugs under New York's workers' compensation program:

1. Will workers' compensation cover my prescriptions for my work-related injury?
Yes, however, the law allows insurance carriers or self-insured employers to choose which pharmacies that you can use to obtain your prescriptions. This does not affect your ability to receive the medications that you need.

2. Will anything stop me from getting the prescriptions that I need?
While the insurer designates which pharmacy or pharmacy network you have to use to get your medications, it does not prevent you from getting medicine when you need it. The network that your insurer chooses must include a pharmacy that is within a reasonable distance of your home, or it must offer a mail order service.

3. Can I get a prescription elsewhere in a medical emergency?
If you experience a medical emergency and it is impractical for you to obtain a prescription from a pharmacy in the chosen network, then you can choose a pharmacy from outside the designated network.

4. Can the carrier tell me which drugs I have to take?
No, it cannot. A carrier can tell you where you need to obtain the medications, but it cannot tell you which drugs you have to take. What you take is between you and your doctor. If the carrier refuses to pay for a specific drug, then the Workers' Compensation Board will resolve the dispute.

5. When will I be reimbursed for my drug costs?
Under the law, a carrier must pay the "undisputed" portion of a claim within 45 days of receiving it unless the carrier argues that the prescription was not for a work-related injury or illness.

Even if the carrier is disputing a claim, it still must pay the undisputed portion within 45 days, and it must notify you as to why the claim is not being paid, and why, or request additional information from you.

To learn more about workers' compensation claims, contact Katz, Leidman, Grossman, Wolfe & Freund for a free case evaluation with a New York workers' compensation attorney!