Workers' Compensation Won't Approve My Prescription Medications

In Pennsylvania, the Workers’ Compensation Act does not require a workers’ compensation insurance carrier to “pre-approve” payment of medical treatment, which includes prescription medications. 

We've seen first-hand the frustration and despair an injured worker experiences when trying to have a work-related prescription filled at their local pharmacy.  Customarily, when the local pharmacy receives a prescription that should be covered under a workers’ compensation claim, the first thing the pharmacy will do is call the workers’ compensation insurance carrier.  The pharmacy will only fill the prescription if the workers’ compensation adjuster confirms that it will, in fact, pay for the prescription, “pre-approving” the payment of the medical treatment.

As there is no requirement that an adjuster “pre-approve” payment of medical expenses, the workers’ compensation insurance carrier is well within its legal rights not to promise the pharmacy in advance to pay for a prescription before it has been properly billed by the pharmacy.  If the pharmacy fails to obtain “pre-approval,” or is unable to even speak with the adjuster, it will not fill the prescription or will only do so if the injured worker pays for the prescription out of pocket and/or the prescription is billed through the injured worker’s personal health insurance, leaving injured workers without the medications they need.

In order to ensure that an injured worker has their prescriptions promptly filled and billed appropriately we recommend injured workers utilize pharmacy companies that specialize exclusively in filling prescriptions for injured workers.  These pharmacy companies that specialize in filling workers’ compensation prescriptions do not typically have brick and mortar locations.  They will instead have the prescriptions overnighted to your residence.  If the prescriptions are time sensitive and having them overnighted to your residence is not acceptable these companies have relationships with brick-and-mortar pharmacies that will permit you to pick-up your prescription from that pharmacy.

Most importantly, these pharmacy companies know and understand appropriate billing procedures under Pennsylvania’s Workers’ Compensation Act.  As such, these companies do not seek “pre-approval” before filling your work-related prescription, instead these companies will promptly fill your prescription and then bill the workers’ compensation insurance carrier.

Who will fill my workers' compensation prescriptions without pre-approval?

Although, there exists a number of pharmacy companies that specialize exclusively in filling prescriptions for injured workers, our office has worked extensively and have had good experiences with Injured Workers Pharmacy, LLC.

If you are having difficulty with the workers’ compensation insurance carrier not promptly filling or paying for your work-related injury prescriptions, contact our Erie, PA Workers’ Compensation Attorneys for a free consultation to discuss your legal rights and options.

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