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Are prescription drugs covered by workers’ compensation?

Worker's comp provides drug coverage.Yes. New York workers’ compensation medical benefits include prescription drug coverage for injured employees. However, the workers’ compensation claims process can be complicated and the drug coverage aspect is no exception. There are drugs that are preapproved, ones that require prior authorization, and specific criteria you need to follow to seek and gain approval for a medication. If you were hurt on the job and you’re counting on workers’ compensation to pick up the tab for your prescriptions, you can benefit from the representation of a skilled attorney.

In response to legislation enacted in 2017, the New York State Workers’ Compensation Board (WBC) established a drug formulary that lists a number of medications that can be prescribed to injured workers without prior authorization. This list is based on a drug’s efficacy and suitability for treating injuries and illnesses covered by the state’s workers’ comp statute, with approved meds categorized as “Phase A,” “Phase B,” “Perioperative,” and second-line therapies the can only be used when other approved drugs have failed to resolve the issue in question. Workers can seek authorization for non-formulary drugs not included in the list.

You can also request authorization to use a name-brand formulary drug when a generic is available, combination products not listed in the formulary, compounded drugs, or a brand-name drug when a generic version with similar active ingredients is available over-the-counter, but in a strength or dosage that differs from what the doctor prescribed.

Unfortunately, the prior authorization process is lengthy, complex, and rife with potential pitfalls. Don’t risk a denial or a delay in coverage. Let the knowledgeable and highly-experienced New York workers’ compensation attorneys with O’Connor Law PLLC handle your claim from start to finish, and ensure you receive the benefits—including the prescription drug coverage—you deserve.

Take Advantage of a Complimentary Consultation

Contact O’Connor Law PLLC today to schedule an appointment for a free initial consultation to discuss your workers’ compensation case. You can also request a complimentary copy of our guide, New York Workers’ Compensation: What You Need to Know If You’ve Been Hurt on the Job, for additional information.

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