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 it is not possible for you to bill electronically, you are not able to reach someone at the WSIB and the medication is required immediately. The patient needs to submit a Medication Reimbursement Form.
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.
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.
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.
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.
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.
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 at 1-800-387-0750 from Monday to Friday 7:30 a.m. to 7:45 p.m. and connect with the drug verification team. 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.