What to do when a workers' comp prescription is delayed

How delays generally happen

A workers' comp prescription involves more parties than an ordinary one: you, your doctor, the pharmacy, your employer and the insurer or claims administrator. If any one of them is missing a piece of information, the prescription can stall.

The most common gaps are a claim that hasn't been set up yet, a claim number the pharmacy doesn't have, a medication that needs approval under your claim, or a question about whether the injury is accepted. Sometimes the pharmacy simply needs to confirm details with the doctor's office.

Rules differ by state and by claim. Some states and claims have specific processes for approving medications, and your adjuster is the best source for how yours works.

• Claim not set up, or claim number missing
• Medication waiting for approval under the claim
• Questions about whether the injury is accepted
• Pharmacy waiting on details from the doctor's office

Questions to ask

Start with the pharmacy, because they can tell you what's actually holding things up. Ask them exactly what is missing or pending, and write down the answer.

Then call your adjuster. Ask whether anything is needed from you or your doctor, and when a decision is expected. If the pharmacy needs something from your doctor, call the doctor's office and pass on precisely what was asked for.

If you have a workers' comp attorney, let them know about the delay.

• Pharmacy: What exactly is missing or pending?
• Adjuster: Is anything needed from me or my doctor?
• Adjuster: Is this medication approved under my claim?
• Doctor's office: Can you send what the pharmacy asked for?
• Doctor: What should I do if I run out while this is sorted out?

What to have ready

Having details in front of you makes each call shorter. Keep a simple log of who you spoke to, when, and what they said — it helps if you need to follow up or explain the situation to someone new.

If you have more than one prescription, note which ones are delayed and which arrived. Delays often affect one medication but not others, and that detail helps the pharmacy and adjuster pinpoint the cause.

• Claim number and date of injury
• Adjuster's name, phone number and email
• Employer name
• Prescribing doctor's name and office number
• Pharmacy name and phone number
• A call log with dates, names and outcomes

About the Prescriptions.plus Home Delivery Program

Prescriptions.plus is an educational site, not a pharmacy. Through the Prescriptions.plus Home Delivery Program, doctors can send prescriptions to our licensed partner pharmacy, and medication is delivered to the patient's door.

If getting to a pharmacy is part of what's making things hard, ask your doctor whether your prescription can be sent to our partner pharmacy. A $5 dispensing fee applies, and a delivery fee applies. Eligibility depends on the prescription, the doctor and the claim — a delivery pharmacy still needs claim details, and it can't resolve a pending approval on its own.

Some medications, such as Schedule II controlled substances, may not be available by mail — your partner pharmacy will advise.

If something goes wrong

If a delay drags on, follow up in writing with your adjuster and keep copies. Ask whether there is a process in your state for disputing a decision about medication; your attorney, if you have one, can advise.

Don't stop taking a medication suddenly without talking to your doctor, and don't take someone else's medication to fill a gap. Call your doctor's office if you're running low.

If you have severe pain, new symptoms or a reaction to a medication, get medical help. Medical emergency? Call 911.