New Arizona Law Allows Mail-Order Meds for Workers’ Comp Beneficiaries

On April 12, 2021, Governor Doug Ducey signed new legislation that allows injured workers who are receiving doctor care under workers’ compensation to utilize mail-order pharmacies. The law also allows private self-insured employers to use direct care for their employees who are injured on the job.

Both the Arizona state House and Senate unanimously passed S.B. 1042 in early April 2021. The bill was introduced to amend Arizona’s current workers’ compensation statutes that only allowed injured workers to be reimbursed for medications that were dispensed through a traditional pharmacy.

The new stipulation states that pharmaceuticals by mail-order pharmacies are acceptable as long as the medical provider referring the patient doesn’t get a rebate, refund, commission or compensation in any way for the referral.

In addition to allowing mail-order pharmaceuticals, S.B. 1042 also allows private, self-insured employers to continue to direct the care of their employees (in terms of medical, surgical and/or hospital care). Pharmacies and health care providers can also begin separate contracts and/or a network to control workers’ compensation fees.

Under this condition, reimbursement for mail-order pharmaceuticals will be doled out at a negotiated rate.

S.B. 1042 went into effect immediately after Gov. Ducey signed the bill into law.

Doctor requirements for workers’ comp in Arizona

For the most part, S.B. 1042 grants those receiving benefits from workers’ compensation the option to get their medications through mail-order. However, there are certain requirements for workers’ compensation with regards to Arizona employers who are self-insured.

For the majority of Arizona work injury cases, injured workers have the option to choose their own doctor for treatment as long as they visit them before the second visit to a doctor of the employer’s choosing.

For example, after being injured at work, let’s say you choose to go to an urgent care center for treatment. If you have to go back to this urgent care for a second visit, the doctor you see there will now be your doctor for the duration of your treatment.

If your employer isn’t self-insured and directs your medical care, and you want to choose your own physician, you should choose one who has experience with handling workers’ compensation cases and see them for treatment. This is because they will have a better understanding of how the system works, which can go a long way to reducing the amount of stress you experience during the process.

Additionally, we also recommended that if you need to continue seeing a doctor for treatment that you notify the workers’ compensation insurance company that your employer utilizes. Likewise, you should also be prepared to pay for your initial visit out of pocket. Let this physician know that you’re being treated for a workers’ compensation injury.

If your employer is self-insured with direct care authority, your options are more limited as you’re typically required to see a physician of their choosing for work injury treatments.

If you do want to change physicians and your employer is self-insured, you can file a Request to Change doctors form with the Industrial Commission of Arizona (ICA). Through this form, you can request permission to change doctors.

What can I do if my request is denied?

In the event that your employer’s insurance carrier denies your request to choose your own doctor, you should seek the advice of an experienced workers’ compensation attorney as soon as possible.

Arizona workers’ compensation laws

If you’re injured on the job in Arizona, then you are most likely entitled to 3 types of benefits under the workers’ compensation system:

1. Medical expenses
2. Wage loss and disability
3. Death benefits

In Arizona (and all other states) workers’ compensation is a ‘no fault’ system, which means that you’re eligible for compensation even if you’re partially at fault for the injury. Exceptions to this rule involve self-inflicted injuries and those that occur while you were under the influence of drugs and/or alcohol.

The last thing you need to worry about if you’ve been injured at work is being compensated while you’re healing, or how you’re getting your medication if you’re too injured to drive. In the event you or a loved one are hurt on the job, contact an experienced workers’ compensation attorney at the Law Offices of Robert E. Wisniewski today. We will provide you a free consultation.