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Does Workers' Compensation Cover Prescription Medications?

When your doctor prescribes medication for a routine concern, you expect the pharmacy to fill the prescription. You also rely on your insurance company to cover at least a portion of the cost. What happens, though, when you need medicine to treat an illness or injury related to a Workers’ Compensation claim? Workers’ Compensation procedures vary slightly in every state, but here’s the general process you’ll undergo as you get your prescription medications filled during your treatment a Workers’ Compensation illness or injury.

Follow Workers’ Compensation Filing Protocols

You generally have to file a Workers’ Compensation claim within 30 days of the illness or injury. Follow the correct reporting and filing procedure to improve your chances of getting all your treatment, including medicine, covered.    

Then, visit an approved doctor and complete all recommended treatment. Your employer will provide you with a copy of the participating doctors you may visit for your Workers’ Compensation claim treatment. You risk paying out-of-pocket for your treatment and medicine if you fail to comply with these protocols.

The Workers’ Compensation Process for Medication Prescriptions

Workers’ Compensation in many states covers all prescribed and over-the-counter medications your doctor recommends during the first seven days after your reported illness or injury. That means you can begin to address any pain and other symptoms right away.

Any medication requests your Workers’ Compensation doctor submits after the first seven days must go through several channels. In most cases, you won’t receive a prescription you can fill right away. Those general steps include:

  • You visit your doctor, and he or she recommends medicine that will treat your illness or injury.
  • The doctor records the medication in the Workers’ Compensation paperwork and submits the request to the Workers’ Compensation insurance carrier.
  • A third-party administrator will review your medical record to ensure the medication prescribed is necessary and essential for your recovery.
  • The insurance adjuster or case manager will authorize or decline the prescription. In general, ongoing prescriptions are approved. The adjuster may need to see a Letter of Medical Necessity from the doctor before approving new prescriptions.
  • A Nurse Case Manager may provide ongoing review of your Workers’ Compensation medical records and prescriptions, particularly if you take opiates or have been prescribed other medication for longer than six months.
Workers’ Compensation benefits allow you to visit a doctor and receive the treatment you need, including prescription medications, for an illness or injury. Understand how the process works as you access the medicine that supports your recovery and prepares you to return to work. If you need help understanding your benefits, review your Workers’ Compensation benefits package or talk to your employer.
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