New First Fill pharmacy benefit

In March SAIF will begin a First Fill pharmacy program that injured workers can use until a decision has been made on their claim. Although Oregon law does not require us to provide this benefit, we have elected to provide a limited number of cost-effective medication benefits for new claims filed for work-related injuries or illnesses in order to help injured workers get through those first difficult days after an injury and before the claim is accepted.

First Fill prescriptions will be billed directly to the Oregon Prescription Drug Plan (OPDP), which is administered by The ODS Companies, making it more convenient for workers to get the medications their health care providers prescribe. Since this program is for prescriptions needed before acceptance or denial of a workers' compensation claim, not all medications will be covered.

Making it easier for injured workers
Pharmacy bills will be handled through OPDP and paid by SAIF, even if the claim is later denied. This means there will be no out-of-pocket costs to the injured worker or to the policyholder for a limited number of prescription medications related to the injury.

If a health care provider prescribes medications not covered by this program, the worker will need to pay out-of-pocket for those medications. Later, if a claim is accepted, the worker may submit a Request for Reimbursement of Expenses form for reimbursement of those out-of-pocket expenses.

The First Fill pharmacy program is designed to make it easier for workers to get many of the medications prescribed for their recovery, and is another way that SAIF is helping our customers get the care they need.

It's important that policyholders notify SAIF immediately when they learn of a workplace injury in order for this program to work most effectively. First Fill will not be available to injured works who have not filed a workers' compensation claim with SAIF.

New pharmacy benefits manager
In addition to First Fill, SAIF will convert to the Oregon Prescription Drug Program as the pharmacy benefits manager (PBM) for worker prescriptions in March. SAIF and OPDP were both created by the people of Oregon through acts of the state legislature, and both are dedicated to the people and businesses of Oregon. Workers who are enrolled with the current PBM will be notified of the change. By joining OPDP and bringing the new First Fill process to the Oregon market, SAIF continues to set the industry standard for affordability, availability, innovation, efficiency, and service quality.

If you have any questions, please do not hesitate to contact Allison Knight at 800.285.8525 or allkni@saif.com.

Frequently Asked Questions about SAIF's First Fill program and conversion to the Oregon Prescription Drug Program.