Drug Formulary and Forms
WCB’s prescription drug coverage—a guide for physicians
WCB’s Drug Formulary helps ensure workers injured at work have access to medications that support safe recovery and return to work. The formulary is managed through a partnership with Medavie Blue Cross, which processes prescription claims through the PayDirect system.
What the formulary is
The WCB Drug Formulary is a list of prescription medications that may be covered for workers with approved WCB claims.
It helps physicians and pharmacists know which drugs are approved, when special authorization is required, and how coverage is applied.
Formularies are based on the type and severity of the injury or illness. This means that the drugs covered for one worker may differ from another, depending on the nature of their injury.
What drugs are covered
- Drugs that support safe recovery and return to work
- Drugs commonly used for the type of injury or illness being treated
- Both opioid and non-opioid medications, with specific criteria and time limits for each
Most injuries—such as musculoskeletal, bone, nerve, wound, burn, or other traumatic injuries—include automatic coverage for many opioids for up to 12 weeks after the date of injury.
For serious injuries or illnesses, such as cancer, opioids may be covered for up to 24 weeks.
Coverage is also limited by safe dosage quantities and time periods to support best medical practice.
Prescription coverage info for your patients
If your patient’s have questions you can direct them here for answers about drug coverage.
How to determine if a drug is covered
Coverage depends on:
- The worker’s approved claim and injury type
- Whether the drug is included in that injury’s formulary
- Whether special authorization is required
If a drug needs special authorization, you’ll need to complete the appropriate form before the prescription can be filled.
Important details to provide for pharmacies
- WCB group number: 0008726000
- Claim number format: 00 + 7-digit number
- Pharmacy records must exactly match WCB’s information (name, date of birth, address). PayDirect pulls data directly from WCB systems.
Medavie Blue Cross and PayDirect
Through WCB’s partnership with Medavie Blue Cross, approved prescription drugs are available at any pharmacy counter in Atlantic Canada.
If the medication is included in the worker’s formulary, it is covered automatically at the point of sale—no out-of-pocket expense is required.
WCB formularies contain thousands of drugs organized into benefit sets by injury/illness. Because coverage varies by case, a complete public list isn’t available.
Fielding common questions from pharmacies
- If pharmacies have questions about drug cost or reimbursement, direct them to Medavie Blue Cross Service Line at 902-496-5810 or 1-855-496-5810.
- Rates paid under the program are not negotiable, and WCB cannot top-up or coordinate benefits between multiple claims.
Special rules for opioids
WCB follows evidence-based best practices to ensure opioids are prescribed safely and only when medically appropriate.
Coverage is time-limited and monitored through the Nova Scotia Prescription Monitoring Program (NSPMP).
Special authorization and patient agreements are required for longer-term use. See the forms and guides below.
Special Authorization Forms
These forms must be completed by the prescribing physician. If you prescribe a medication that is not automatically covered through the claim's formulary, you will need to submit a Special Authorization form to Medavie Blue Cross. Since Health Canada sets the formulary, you will need to explain why the worker needs a medication outside of Health Canada's recommendations for their condition. These forms allow the prescribing physician to present this reasoning to Medavie Blue Cross for review.
- Medical Cannabis Initial Request Form (PDF)—for the patient’s first medical cannabis request.
- Medical Cannabis Extension Request Form (PDF)—for renewals.
- Opioid (Pain Medication) Special Authorization Request (PDF)—for opioids not automatically covered, or when automatic coverage has ended.
- Non-Opioid Special Authorization Request Form— for any non-opioid medications not covered in the worker's formulary.
- Substance Abuse Assessment Form (PDF)—must be submitted with the patience’s first opioid special authorization form request.
- Mandatory Generic Exemption Form (PDF)—for situations where the patient medically requires a brand-name drug instead of a generic drug.
Agreements for you and your patient to sign
- Opioid Treatment Agreement
- Opioid Informed Consent and Agreement
- Medical Cannabis Patient Treatment Agreement – Sample 1
- Medical Cannabis Patient Treatment Agreement – Sample 2
Reference documents
These documents provide detailed coverage criteria and guidance for prescribers:
- Medical Cannabis Guidelines
- Opioid Coverage Guide
- Non-Opioid Coverage Guide
- Special Authorization Drugs and Coverage Criteria
- Special Authorization Process
- Special Authorization Billing Information
- Important Notes for Pharmacies
- Conditional Coverage
- Criteria Codes
- System Adjudication Messages to Pharmacies
Resources and information
These resources offer additional guidance and professional support for safe prescribing and pain management.