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 www.tmesys.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 Optum Customer Care at 1-800-304-1764 or the Pharmacy Phone line at 1-609-883-1300 (1-800-232-6600), ext. 6210.
- Medications related to your work injury will be reviewed and authorized by your NJM Claims Representative and/or our RN Pharmacy Precertification Team.
Pharmacy-Related Documents for Injured Employees and Medical Providers:
NJM Formulary FAQs - Frequently asked questions for injured workers.
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.