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Prescription cards in workers' compensation cases

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Prescription cards in workers' compensation cases
By Don Marston, Esquire

            The use of prescription cards/plans by insurance carriers in workers' compensation cases is not new.  However, until recently, the injured worker had the option of taking his prescription to his local pharmacy to be filled rather than using the prescription card/plan offered by the insurance carrier.  Over the years, the problems associated with injured workers having their prescriptions approved and paid for by the insurance carrier has led to the use of other prescription services (i.e., Injured Workers' Pharmacy, Summit Pharmacy, etc.).  These services made the life of a claimant's attorney and his support staff much less stressful because these services would fill the prescription without question and then bill the workers' compensation insurance carrier.  They would also resolve most billing issues without involving the attorney or the injured worker.

            Apparently, these prescription services were too pricey for the insurance carriers.  Thus, the push began to compel the injured worker to use a prescription card/plan selected by the insurance carrier.  This push culminated in a Superior Court decision issued on August 23, 2012.  This decision confirmed the Industrial Accident Board's ruling that the insurance carrier has the absolute right to dictate how an injured worker has his or her prescriptions filled.

            Now that the insurance carriers have won this right, what are they doing with it?  As many injured workers will be able to confirm, this new approach to filling prescriptions has not made life easier for them.  For example, when the injured worker tries to use the mandated prescription card/plan, they are often confronted with an inability to obtain their medication for a variety of reasons:

  • Their case is "closed".
  • The card is "inactive".
  • The card has not yet been "activated".
  • The prescription has not yet been approved by the insurance adjuster.
  • The adjuster is "not available" when the pharmacist calls for approval.
  • The insurance adjuster needs additional medical records and/or other information from the prescribing doctor before the medication will be approved. 


            As anyone who has been confronted with these excuses can confirm, the delay in obtaining the necessary medication can be extremely frustrating and stressful to the injured worker.  The good news is that an experienced workers' compensation attorney has a variety of tools at his or her disposal to make sure the injured worker obtains the medication he or she needs. 


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