“Secretive drug policies putting injured workers at risk, critics say” / Sara Mojtehedzadeh (Toronto Star, Aug. 29, 2016)
Will the medication I’m prescribed by my doctor for my work injury (or illness) be covered by the WSIB? It seems a simple enough question. However many injured workers, often the vulnerable and low-income, “are being bounced around … they won’t find out until they turn up to the pharmacy that (a prescription) is not approved.” (Maryth Yachnin, lawyer with Industrial Accident Victims’ Group of Ontario (IAVGO).
Accountability and integrity of the process?
Freedom of information requests by the legal clinic to make public the drug formulary public and shed light on the Board’s Drug Advisory Committee, including names of members, have been rejected. In its response to The Star, the Board said releasing the list of prescriptions the Board would pay for would be misleading, given that they do not necessarily guarantee or limit entitlement. (Yet Nova Scotia’s WCB makes available online a list of medications with specific criteria for coverage. Transparency in the decision process and accessibility and ease of use by treating physicians and injured workers are key criteria identified by Rand in its 2016 report (p.27) on implementing a drug formulary for the California workers compensation program. )
Drug benefit costs cut
As IAVGO detailed in its June 10 Open Letter endorsed by over 140 organizations and individuals, since 2009 the WSIB has cut its spending on drug benefits by almost 30%. While President and CEO Tom Teahan attributes this to the declining cost of pharmaceuticals and reducing inappropriate use of narcotics, critics point to a systemic problem with treating doctors’ recommendations being overridden by the Board and its medical consultants. WSIB figures show the number of Schedule I claims receiving drug benefits has fallen from 63,892 in 2010 to 46,919 in 2014, a decrease of 26%, while the number of Schedule 1 claims allowed by the WSIB decreased by only 2% over the same period.
When denied coverage for prescription drugs, many who cannot pay out of pocket face the dilemma of doing without and compromising care, or foregoing workers’ compensation in favour of social assistance to get their needed medication.