First Fill pharmacy program
Injured workers may be eligible for SAIF's First Fill pharmacy program, which provides a limited number of common prescription drugs for work-related injuries or illnesses until a decision has been made on their claim.
First Fill pharmacy bills will be handled through the Oregon Prescription Drug Program (OPDP) and paid by SAIF, even if the claim is later denied. If a medication is covered and the prescription doesn't exceed the limit, SAIF will pay the full cost of the medication.
If a medication is not covered, a covered one can be prescribed instead, or the worker may pay out-of-pocket for it and request reimbursement if and when the claim is accepted. If the worker requests a brand-name drug when a generic one is available, and her reimbursement request is approved, only the cost of the generic drug will be paid.
The medication available in the limited pharmacy program is unique to each injured worker's claim. Providers can call the adjuster (800.285.8525) for more information.
View the First Fill prescription drug list.
View the Extended SAIF formulary list.
Find a pharmacy in your area.
CareMark, Kaiser, and Majoris are the MCOs that SAIF contracts with. You can go to our Business Online application to find out which pharmacy program an injured worker is enrolled in. (The login box is on the homepage of this guide. You'll need to create a Business Online account, if you don't already have one.)
Please contact the MCO directly to see its formulary.
Oregon Prescription Drug Program (OPDP)
OPDP is a benefit that helps workers get medications they need for the accepted condition or conditions.
SAIF uses OPDP to administer pharmacy benefits for the workers whom SAIF serves each year. Under OPDP, injured workers may not have to pay out of their own pocket for medication related to their workplace injury.
The Workers' Compensation Division (WCD) has provided new resources for attending physicians and other prescribers to assist in the review and appropriateness of opioid therapies.
The new reference materials include talking points that clarify when to consider prescribing or discontinuing these medications, recommended treatment goals, opioid therapy agreement advice, and instructions regarding screening for addiction.
The guidelines are provided in two printable forms for short-term opioid use (less than 90 days) and for long-term opioid use (more than 90 days). The references used to establish the guidelines are attached to them for physician review.
In addition to the guidelines, WCD created an opioid dosage calculator to ensure providers are aware of the morphine equivalent when writing prescriptions of these medications.
Clinical justification form (4909)
Under WCD rules, medical providers must complete a form (4909) before prescribing more than a five-day supply of Celebrex, Cymbalta, Fentora, Kadian, Lidoderm, Lyrica, and OxyContin.
Read the WCD bulletin for more information on this.
Additional help with medications
If you have questions about a prescription for an injured worker, or about any pharmacy issue related to a claim, don't hesitate to contact the assigned adjuster if it's related to a SAIF formulary, or the MCO if it's related to its formulary.
Remember, you can find out which MCO an injured worker is enrolled with by checking the claim information in Business Online. Go to the homepage to log in.
Pharmacists: If you can't find the information you're looking for on these pages, please call us at the number above. We're here to help you care for our injured workers.