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Northwest OH Legal Blog

Tuesday, November 15, 2016

Prescription Coverage Under Workers Compensation

When someone suffers a workplace injury, the Bureau of Workers’ Compensation (BWC) is required to reimburse the worker for all medical treatments related to his or her workplace injury. This includes medications necessary to treat all allowed conditions. But like everything else in Workers Compensation, prescription coverage is a process.

Prescriptions are managed by a third party called OptumRX. Prescriptions can be filled at your local pharmacy as long as it is BWC certified. The Ohio Bureau of Workers’ Compensation website, bwc.ohio.gov, offers the following on billing prescriptions to Workers’ Comp:

1. A pharmacy can fill a ten day supply of a claimant’s first prescription if the claim is yet to be allowed. The pharmacy will need your social security number, date of injury, and should write “for work-related injury” on the script.

2. If the claim has been allowed, all the claimant needs to do is provide the prescription and the claim number and the BWC will cover all allowed prescriptions.

3. If a claimant needs to be reimbursed for prescriptions, the claimant should ask the pharmacy to re-submit the bill and the pharmacy will provide reimbursement. The claimant can also file a C-17 to request reimbursement, which can be found here: https://www.bwc.ohio.gov/downloads/blankpdf/C-17.pdf.

It is important for the injured worker to remember that the BWC will only reimburse allowed prescriptions. The BWC publishes a list of medications it will cover known as a formulary. The claimant’s physician should check the formulary before prescribing medications to make sure it will be reimbursed.  

A common reason a prescription will not be found on the formulary is if it is name-brand prescription and a generic is available. When this is the case, the claimant will be responsible for the price difference between the name brand and generic prescription. Claimants should always ask the doctor for generic medication when available.

Sometimes prescriptions will require additional documentation to be reimbursed. This is especially true in the case of muscle relaxants and opioids. Also, if the prescription does not appear to be for the allowed conditions, the doctor may have to submit additional documentation relating it to these conditions.

As always, you may contact Allotta | Farley Co., L.P.A. with questions regarding your Workers Compensation claim. 


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With offices in Toledo and Lima, OH Allotta Farley Co., L.P.A. serves clients throughout northwest OH with various legal matters. Areas of service include Allen County, Ashland County, Auglaize County, Crawford County, Defiance County, Erie County, Fulton County, Hancock County, Hardin County, Henry County, Huron County, Lucas County, Marion County, Mercer County, Morrow County, Ottawa County, Paulding County, Putnam County, Richland County, Sandusky County, Seneca County, Van Wert County, Williams County, Wood County, Wyandot County.

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