The WSIB drug benefit program pays for medications prescribed for work-related injuries or illnesses.
We use TELUS Health as our electronic drug adjudication provider. Pharmacists should consult the TELUS Health Pharmacy Manual (PDF) for further information.
Pharmacies should note the following to complete prescription transactions:
- Insurer: TELUS (formerly Assure Health)
- Carrier ID: 49
- Group ID: 2000
- Client ID: please use WSIB claim number + 01
We can do a one-time approval for manual prescription receipts if you aren't able to bill electronically and, you aren't able to reach someone at the WSIB and the medication is required immediately. The patient needs to submit a
.
Pharmacists prescribing for minor ailments
As of January 1, 2023, Ontario pharmacists are authorized to prescribe certain medications for a defined list of minor ailments, based on the Pharmacy Act, 1991 and Ontario Regulation 202/94. While pharmacists can prescribe medication for minor ailments, to make a claim with us we require a diagnosis from a health care provider who can submit a Health Professional's Report (Form 8). The diagnosis and related medical information support our decision-making process for entitlement and return-to-work planning.
We are currently working with the Ontario Pharmacists Association to find ways to deliver more accessible health care to people with work-related injuries and illnesses.
FAQs for pharmacists
What should I do if a person is seeking a minor ailment assessment due to a work-related injury or illness?
You should encourage them to get additional health care from a health care provider who can submit a Form 8 to us. Also encourage them to report the injury or illness to their employer and to us.
If the minor ailment assessment is for someone with an approved claim and entitlement, please email DrugBenefitProgram@wsib.on.ca to determine if it is eligible for payment by WSIB. You can review the list of medications included on WSIB formularies on our website.
Will the WSIB accept a Form 8 from a pharmacist?
No, pharmacists are not authorized to fill out or submit a Form 8. People with a work-related injury or illness need to get additional health care from a health care provider who can submit a Form 8. Please encourage them to report the injury or illness to their employer and to us if they haven’t already. Health care providers include a chiropractor, physician, physiotherapist or registered nurse (extended class).
If they do not have additional health care options available, have them contact us to learn about community-based treatment options and other programs that may be accessible to them.
Coordination of benefits
Please note that any portion of a drug benefit claim not paid by the WSIB should not be charged to the patient as per the Workplace Safety and Insurance Act, nor can payments be coordinated with a secondary plan, including provincial drug plans.
Generic substitution
The WSIB will pay for the dispensing of generic medications unless a prescriber indicates on the prescription that no substitution is to be made to the brand name product, or if the patient has experienced a documented adverse event to the generic product. The WSIB will not approve a request for a brand name product from the patient.
Biosimilar substitution
Health Canada has reviewed and approved biosimilar biologic drugs to be equivalently safe and effective as the originator biologic drugs. The WSIB prioritizes the provision of biosimilar drugs for funding of those who are new to treatment, similar to that of Ontario Drug Benefits and Cancer Care Ontario, in cases where a request for an originator is made and a biosimilar product is available.
While both the originator biologic and its biosimilar(s) are listed on the WSIB Formulary, the biosimilar will be preferentially funded based on advice from the Drug Advisory Committee. In these cases, prescribers may be required to provide a prescription for the biosimilar. We can consider requests for exceptions from the prescriber in rare situations. While deemed equivalent, originator and biosimilar are not interchangeable.
Dispensing fee
The WSIB will reimburse a dispensing fee equal to the dispensing fee paid by the Ontario Drug Benefit Program in the province of Ontario. Out-of-province pharmacies can also electronically process drug claims, including dispensing fees, on a claim-by-claim basis, (discussion with the WSIB may be required to set up adjudication). As per the Workplace Safety and Insurance Act, an injured person should not be charged for the difference between the set fee and the pharmacy-dispensing fee.
Dispensing limits
A maximum 100-day supply for maintenance medication can be dispensed per prescription.
Vacation supply: Vacation supply of regular maintenance medications may be granted for a period up to 200 days if a patient is travelling out of province. For opioid medications, a prescription authorizing the vacation supply is required from the prescriber.
Quantity limits: Some medications may have quantity limits, such as narcotics, erectile dysfunction drugs and certain NSAIDs. Narcotic quantity limits are generally set based on prescription instructions. Erectile dysfunction drug limits are only applied to specific doses that are recommended for when-needed use. Drugs for erectile dysfunction treatment are limited in quantity to 12 tablets per month or 36 tablets in three-month period. For the NSAID ketorolac, the quantity limit is set to a five-day supply. When submission of a claim at a pharmacy results in a notice of quantity maximum exceeded, you may call us for additional guidance.
Covered medications
The WSIB drug benefit program covers prescription and over-the-counter products that are classified as a life-sustaining product (e.g., insulin, iron) and/or support the patient’s return to work and improvement in function. All products paid by the WSIB drug benefit program require prescriptions, including over-the-counter products.
Our drug benefit program formulary search provides more information about medications that are potentially covered. For medications not found in the search, please read more about non-formulary drugs.
Prescription filling questions?
Pharmacies should call the WSIB and connect with a drug verification team. Visit our contact us page for information about how to get in touch with us. Someone can then verify coverage and provide more information on rejection messages e.g., DIN not covered, DIN/PIN not a benefit, invalid cardholder. All other questions should be directed to TELUS Health.