Pharmacy Benefit Information
Our Pharmacy Benefit program covers the cost of prescriptions for an injured employee's workers' compensation-related injury or illness with no out-of-pocket expense. The program is administered by the Optum Tmesys network and is accepted at most major pharmacy chains.
How the Program Works:
Once your workers' compensation claim is established, an information letter and prescription card will be mailed to you at your home address. If you have not received a card within two days after your claim is reported, please contact your NJM Claims Representative.
You should always present the prescription card and your claim number at the pharmacy when filling your workers' compensation-related prescriptions.
The prescription card is accepted at most pharmacies, including large retail chains. A short list of pharmacies closest to your mailing address will be listed on the information letter. To review a list of other network pharmacies, please visit workcompauto.optum.com and click on Pharmacy Locator or call 1-866-940-4459.
For your convenience, you may also be eligible to have your prescriptions sent to your home address. For more information, contact the Pharmacy Precert line at 1-609-883-1300 (1-800-232-6600), ext. 6210.
As of 2/25/21, NJM has adopted the Official Disability Guidelines (ODG) Drug Formulary in addition to the existing NJM excluded formulary. See NJM/ODG Formulary FAQs for more information.
Medications related to your work injury may require review and prior authorization by your NJM Claims Representative and/or our RN Pharmacy Precertification Team if the medication prescribed is not on formulary.
Pharmacy-Related Documents for Injured Employees and Medical Providers:
NJM Formulary FAQs - Frequently asked questions for injured workers and providers.
NJM Excluded/Alternative Medications - A list of medications that are excluded from the NJM Formulary and a partial list of suggested alternative medications.
Letter of Medical Necessity - Any non-formulary medications prescribed for injured workers will require a Letter of Medical Necessity completed by your authorized, treating physician along with pre-authorization by our RN Pharmacy Precertification Team.