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New Rules for Selecting a Pharmacy

With the new Workers Compensation Law allowing insurers to designate the pharmacy, pharmacy network, or mail-order pharmacy you’re using to get your prescriptions, you may have some questions. 

Does this apply to me?

As of July 11, 2007, insurers are allowed to designate where you can get your drugs.  But this doesn’t mean that they all do.  The company had to notify you in writing that they were doing so and had to give you a list of all local pharmacies you could use (along with the location and address of the pharamacy).  They also had to give you instructions about filling or refilling your prescriptions through the mail, internet, or phone.

How is this legal?

Nothing in this new legislation actually prevents you from getting medications when you need them. The insurance companies were all required to include pharmacies that are either a reasonable distance from your residence or offer mail order service.  In emergency situations or where it is otherwise impossible or impractical for you to obtain the medicine you need, you can purchase the drugs from a closer pharamacy.

What about drugs I’m already on?  Can they make me stop taking them?

No.  The law doesn’t have anything to do with the selection of the drugs you can take.  It only governs where you can get the prescription filled.  If your doctor has prescribed the drug, you will be able to get it.

If your carrier is not willing to pay for a specific drug, the Workers’ Compensation Board will decide the dispute, but this has nothing to do with the new drug laws.

When will I get reimbursed for my prescription costs?

One of the big problems with the old law was that there was no specific time set for repayment.  This problem is cured by the new law.

Under the new law, the insurance company has 45 days from the time they receive a claim for reimbursement to pay it.  If part of a claim is disputed, the carrier must pay the undisputed portion within 45 days.  If the entire claim is disputed, they must tell you that they’re not paying and why they’re not paying.