Exception made, prescription approved
A worker complained to the Commission that the WSIB denied him coverage for a topical cream prescribed by his doctor for chronic pain. A nurse consultant told him the cream was not on the WSIB’s formulary, the list of covered medications.
The Commission’s file review showed that the worker had suffered multiple fractures to the same ankle over several years. Eventually, he was diagnosed with a non-healing fracture and complex regional pain syndrome. He tried many treatments, including nerve blocks, medications, and many surgical procedures. The WSIB allowed a 25 per cent permanent disability award.
The letter denying coverage for the topical cream suggested the worker try alternatives, such as Tylenol, opioids, neuropathic oral pain analgesics, or nonsteroidal anti-inflammatory drug. The writer also suggested that the worker’s doctor search for an alternative on the WSIB’s formulary.
The Commission spoke with a manager, who said that a nurse would review the medical information on file. That review revealed that the worker had tried several medications listed on the WSIB formulary and that there were no other options.
The nurse contacted the pharmacy for information about the cream and instructions for use.
Because of Commission inquiries and the WSIB’s subsequent review, the WSIB allowed a three-month trial of the cream. WSIB policy allows for exceptions based on the merits and justice of a case.