Obtaining Prescriptions Under Workers' Compensation

Posted By Katz Leidman Grossman Wolfe & Freund || 10-May-2016

If you have suffered an on-the-job injury or illness, you will likely be prescribed one or more medications by your doctor.

As you know, prescription medications can be very expensive. If you are in a significant amount of pain, you may need your medications so you can function, take care of your basic needs, and perhaps even your family. So, they can be essential.

Will you be able to have your prescriptions filled under your employer’s workers’ compensation insurance? Yes, you will be entitled to receive the medicine you need under your employer’s workers’ compensation insurance.

However, a law was enacted in 2007 that allows self-insured employers as well as insurance carriers to decide which pharmacies you have to use to obtain your prescriptions. This law does not affect your ability to obtain the necessary medications, but it affects where you can get them from.

It is your understanding that your insurance carrier says that you have to obtain your medicine from a pharmacy that they choose, when did this become legal?

As of July 11, 2007, the workers’ compensation law changed so insurers could designate specific pharmacies where injured workers could obtain their medications.

The insurance carrier is required to notify you of this requirement, and they must notify you in writing about which local pharmacies you are allowed to use. They must also provide the names and addresses of these local pharmacies.

What if you need your medicine, but it’s inconvenient to visit one of the pharmacies listed by the insurance carrier? If there is a medical emergency, and it is not practical for you to obtain the necessary medication from a pharmacy in your designated network, then you can purchase the drugs at a different pharmacy.

Can the carrier stop me from receiving the drugs I am on now?

No, they cannot. Under the law, the carrier can only govern where you obtain your prescriptions. The carrier has no authority to tell you which drugs you should take. As before the changes in the law, what you are prescribed is between you and your doctor.

If for any reason the carrier refuses to pay for a drug that you are prescribed, the Workers’ Compensation Board will dispute the issue.

Are you looking for a New York workers’ compensation attorney? Contact our firm at (888) 250-5427 for a free case evaluation!

Categories: Workers' Compensation