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Filling Prescriptions Through Work Comp Insurance in Florida

Filling Prescriptions Through Work Comp Insurance in Florida

Pursuant to Fla.Stat. § 440.13(3)(j), “a sick or injured employee shall be entitled, at all times, to free, full, and absolute choice in the selection of the pharmacy or pharmacist dispensing and filling prescriptions for medicines.” The statute goes on to state that “It is expressly forbidden for the department, an employer, or a carrier, or any agent or representative of the department, an employer, or a carrier, to select the pharmacy or pharmacist which the sick or injured employee must use.” As you can see, the language of this statute is pretty clear. As an injured worker, you are free to select any pharmacy to fill your prescriptions. However, most injured workers are unaware of both their right to freely choose any pharmacy to fill their prescriptions and the potential benefits that filling their prescriptions through pharmacies that cater specifically to injured workers can yield. 

The Prescription Filling Process in a Workers’ Compensation Case

While selecting a pharmacy is easy, getting the pharmacy itself to fill your prescription is often the process that frustrates injured workers the most. Under Fla.Stat. § 440.13(3)(a), a health care provider, including pharmacies, that renders services to an injured worker is required to obtain pre-authorization from the workers’ compensation carrier before the services are rendered. This means that while you are free to select any pharmacy to fill your prescription(s), the pharmacy, as a condition to payment, is required to obtain authorization from the insurance company before it can dispense your medication.

As a result, a pharmacy’s inability to contact an adjuster and obtain pre-authorization can often lead to prolonged delays in your ability to obtain the medication you need, and more often than not, injured workers are frequently left with two choices: pay for the medication yourself and seek reimbursement from the insurance company or wait for the pharmacy to obtain pre-authorization from the insurance carrier. If you choose to pay for your medication and seek reimbursement, the insurance company has 45 days to reimburse you for the out-of-pocket expense regardless of whether it was their mistake that led to the delay or not. If you choose to wait for the pharmacy to obtain pre-authorization from the insurance company, you may experience a delay that can last anywhere from one day to multiple weeks depending on the surrounding circumstances. 

Utilizing the Injured Workers’ Pharmacy (IWP) 

Due to the challenges injured workers face when trying to fill their prescriptions, there are certain pharmacies that cater specifically to needs of injured workers and that make the process of filling your medication much easier. One pharmacy that our workers compensation attorneys recommend is the Injured Workers’ Pharmacy. 

The main benefit that IWP offers injured workers can be found in the medication-filling process. As opposed to obtaining pre-authorization from the insurance carrier before dispensing medication, IWP fills your prescription first and then seeks reimbursement for the medication through the insurance company. If IWP encounters any issues obtaining compensation for the medication they have dispensed, they contact your workers’ compensation attorney who will then seek reimbursement from the insurance company through the claims process if needed, but even in this situation, you will not experience any delays in obtaining your medication. 

The IWP Process  

The process for signing up to use IWP is simple. First, you can contact IWP via phone or online via the IWP website, and a representative will sign you up for the program. Normally, the representative will ask you some basic questions such as your name, address, the name of your physician, etc. Once that is complete, simply notify your doctor that you will be utilizing IWP as your pharmacy, and your doctor will then send your prescriptions directly to IWP in which case you can expect to receive your medication via mail within 24 to 48 hours.  If your doctor gives you a physical prescription, IWP will send you some envelopes you can use to mail the prescription to IWP at no charge to you, and you will receive your medication from IWP within 72 hours. 

Enrolling in IWP with Your Work Comp Attorney

Our work comp attorneys pride themselves on customer service, so if you have additional questions about your workers’ compensation claim, contact our office today to speak with a work comp attorney who will explain the claims process, evaluate your case, and answer any questions you may have.

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