POLICY NUMBER: 2. 3. 4R

Effective Date: June 1^st, 2004
Date Issued: May 14^th, 2004
Date Approved by Board of Directors: May 13^th, 2004
Topic: Prescription Drugs
Section: Health Care
Subsection: General

Policy Statement

The WCB will use a formulary (i.e. a list of prescription drugs recommended in the treatment of specific injuries) whenever possible to determine:

a) which prescription drugs are appropriate for the type of compensable injury;

b) the quantity of the prescription drug;

c) whether the WCB will pay for the prescription drugs.

2. In the cases where prescription drugs are not listed in the formulary, or if an alternative prescription drug is determined to be more appropriate:

a) the WCB will decide what is appropriate;

b) approval must be obtained from a WCB case worker on the advice of a medical advisor; and

c) decisions will be provided in writing to the injured worker and treating physician.

3. Prescription drugs must be prescribed by a physician, dentist or recognized health care provider who is authorized to do so under provincial legislation.

4. Medications that normally do not require a prescription, known as over-the-counter medication, will be covered if:

(a) they are appropriate for the type of compensable injury; and

(b) the health care provider writes a prescription.

5. Medications must be obtained from a provincially licensed pharmacy.

6. If a brand-name medication can be replaced with a generic medication, the WCB will pay the cost of the generic medication unless:

(a) it can be medically demonstrated that the brand-name medication is required; or

(b) the brand-name medication is available at a lower price.

Generic medication substitutes must be listed in the Nova Scotia
Formulary issued by the Department of Health
(www.gov.ns.ca/health/pharmacare/benefits_faq.htm#formulary).

7. This policy does not apply to other health care (services and treatment) covered by the WCB.

Application

This Policy applies to decisions made on or after June 1^st, 2004.

References

Workers' Compensation Act (Chapter 10, Acts of 1994 - 95), Sections 102 and 104.

Executive Corporate Secretary

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