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Pharmacy services

The First Fill programFirst Fill letter

Once your claim is in "deferred" status you may be eligible for SAIF's First Fill pharmacy program, which provides a limited number of cost-effective prescription drugs for work-related injuries or illnesses until a decision has been made on your claim.

There will be no out-of-pocket costs to you for the prescriptions unless a medication not covered by First Fill is prescribed. If you pay for any prescribed medications up until a decision is made (while your claim is deferred), you can request reimbursement for them. However, you can be reimbursed only if your claim is accepted, and you must have itemized receipts to get reimbursed.

One of the first letters you'll receive from us will be about First Fill. Take that letter whenever you go to a pharmacy—it has information they need, such as your claim number, PCN, and SAIF's BIN, and a list of covered medications. It also verifies that you have a workers' comp claim.

If your claim is accepted

If your claim is accepted, the Oregon Prescription Drug Program (OPDP) becomes your pharmacy program.

You will receive a card from OPDP to use when filling prescriptions. Most Oregon pharmacies participate in OPDP, although Walgreens does not.

If at any time you have a problem getting approval from the pharmacy for medication for your accepted condition, have them call your adjuster. For that reason, you should go to the pharmacy during regular business hours, if possible.

Mail order

If you don't live near a pharmacy, you can get medication for your accepted condition by mail order. Ask your adjuster how this works, or contact the mail-order pharmacy directly:

Reimbursements

You may be reimbursed for prescription drugs that you pay for, but the prescription must be valid and necessary for your injury. Always keep itemized pharmacy receipts (not just the one with the total amount) to submit with your request.

Learn more in Getting reimbursed.  

From saif.com

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