Prescription Drug Coverage for Workers
If you’re hurt at work, WCB covers prescription drugs related to your injury, to help you get better and return to work. We do this through a partnership with Medavie Blue Cross, which allows pharmacies to bill WCB directly. This means you won’t have to pay for covered medications out of pocket.
This page explains what’s covered, how your pharmacy bills WCB, and what to do when a medication needs special approval.
What to bring to the pharmacy
To have your prescription covered through your WCB claim, you’ll need to bring the following things to the pharmacy:
- Your Health Card
- Your WCB claim number
- Your prescription
How it works:
- Once your claim is set up, your pharmacy can bill WCB directly
- The pharmacy uses your claim number and date of birth to check coverage
- Medications that are usually recommended for your type of injury get paid for automatically
If your prescription does not go through:
- Ask the pharmacist to confirm the reason why —they can find this information in the Medavie Blue Cross system
- If you must pay out of pocket, keep your official pharmacy receipt
- Submit your receipt securely through your WCB Online account
WCB will:
- Determine why it was not covered
- Explain the next steps
- Let you know if a Special Authorization form is required
How coverage works
When your claim is set up, WCB provides coverage for prescription drugs that are usually recommended for your type of injury. This is called a drug formulary.
What is a drug formulary?
A formulary is a list of prescription drugs commonly used to treat various types of injuries.
Your formulary is linked to the specific injury for your claim.
WCB uses formularies so you:
- Won’t have to pay for medications at the pharmacy
- Get medications proven safe and effective for your injury
- Have access to the right medications at the right time
If a drug is not in your formulary, your doctor may need to complete a special authorization form.
Special authorization (when a drug needs extra approval)
Some medications are not automatically covered. They need Special Authorization before the pharmacy can bill WCB.
This usually happens when a drug:
- Falls outside the formulary for your type of injury
- Is not typically used to treat your condition
- Has specific Health Canada restrictions or criteria
- Can only be used safely in limited circumstances
- Requires higher levels of monitoring
- Has time-limited or quantity-limited coverage
Common examples include:
- Certain opioids and many non-opioid medications
- Medications that can be addictive
- All medical cannabis requests
- Brand-name drugs when a generic is available
- Drugs with known safety risks
If your pharmacy tells you a drug isn’t covered, your doctor may need to complete a Special Authorization request.
How it works
- Ask your doctor to download and complete the correct Special Authorization form.
- Your doctor with fax it to Medavie Blue Cross.
- If approved, future refills will be billed directly to WCB.
Medavie Blue Cross uses medical guidelines to review each request and decides if a special authorization is approved. If approved, the medication coverage on your claim will be updated.
Note: If you received a letter from WCB explaining why a drug wasn’t covered, bring these things to your doctor to speed up the process:
- the letter
- your receipts
- the Special Authorization form to your doctor to speed up the process.
View an up-to-date list of drugs that require special authorization.
Paying out of pocket
You may choose to pay out of pocket for a prescription while you wait for a special authorization decision, so you can start your medication right away. If the request is later approved, WCB will reimburse what you paid.
If you pay out of pocket:
- Keep your detailed pharmacy receipt
- Submit it securely to WCB through your online account
Your receipt must include:
- Your name
- Date filled
- Doctor who prescribed
- Drug name, quantity, and DIN
- Prescription number
- Amount you paid
Quantity limits
Some medications have weekly or monthly quantity limits for safety. If you reach that limit, your doctor may need to request special authorization for an extension.
Special authorization forms
Below is the list of special authorization forms available. Your prescriber will download and complete the appropriate form(s).
- Non-opioid Special Authorization Request (PDF)—for non-opioid medications not in your formulary
- Opioid Special Authorization Request (PDF)—for opioids not automatically covered, or when automatic coverage has ended
- Substance Abuse Assessment Form (PDF)—must be submitted with your first opioid Special Authorization request
- Mandatory Generic Exemption Form (PDF)—for situations where you medically require a brand-name drug instead of a generic
- Medical Cannabis Initial Request Form (PDF)—for your first medical cannabis request
- Medical Cannabis Extension Request Form (PDF)—for renewals
Conditional benefits
Some drugs on the Special Authorization list have conditional status. This means they are covered automatically if you recently filled certain related prescriptions, such as an opioid or an NSAID.
If you paid for those earlier medications out of pocket, WCB won’t see them in the pharmacy system. As a result, the new prescription may be denied.
If this happens, submit your receipts for the earlier medication so WCB can reassess the coverage.
Opioid coverage
Opioids have time-limited coverage to support safe use.
- Most injuries have 12 weeks of automatic opioid coverage
- More serious injuries or illnesses (such as cancer) have 24 weeks
- Quantity limits apply
If opioid coverage ends and you still need medication, your prescriber must complete an Opioid Special Authorization Request (PDF) form.
Medical cannabis
Medical cannabis is not automatically covered. All requests require your prescriber to fill out the relevant form:
- A Medical Cannabis Initial Request Form (PDF) for first-time requests
- A Medical Cannabis Extension Request Form (PDF) for renewals
These forms allow your prescriber to explain why cannabis is medically appropriate for your injury. Medavie Blue Cross reviews these requests using medical guidelines.
Other health care costs
If you’re recovering from a workplace injury or illness, you may need devices, treatments, or other supports.