Workers' Compensation Pharmacy Benefit Information

Pharmacy Benefit Information

Our Pharmacy Benefit program covers the cost of prescriptions injured employees may need for their 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 and pre-authorization by our RN Pharmacy Precertification Team.

Pharmacy Benefit Department Contact Information:

Phone
1-609-883-1300 (1-800-232-6600), ext. 6210

Email
PharmacyPrecert@njm.com