Superior Court affirms the right of the employer to require a claimant to fill her prescriptions through a provider of its choosing.

The issue on appeal in this case is whether the claimant had the right to obtain her prescriptions from a provider of her choosing rather than utilizing the company with which the employer had contracted.

The claimant had sustained a work-related back injury, and there was no dispute as to the medical treatment being provided to the claimant, including the prescriptions her doctor was writing. However, the employer requested a hearing before the Board where it sought an order that the claimant's prescriptions for the work injury should be filled by the preferred provider with which it had a contract, Express Scripts. Under that program, the claimant could obtain the prescriptions at any pharmacy, or even have them mailed to her, and the program would save costs to the employer. The claimant argued to the contrary that she should have the right to obtain her prescriptions from a provider of her own choosing. The Board concluded that the employer's request was reasonable and issued an order directing the claimant to obtain all further prescription medications through Express Scripts.

On appeal, the claimant argued that the Board did not have authority to require her to use Express Scripts and that there was a legislative policy that prohibited the employer from contracting with a preferred provider as it was doing here. The court disagreed and concluded that § 2322 and §2323 of the Act deal with a claimant's right to select medical providers of her own choosing in treating the work injury, but they do not say anything about the right of the employee to select a specific pharmacy for getting medications prescribed by her treating physician. The court concluded that a pharmacy is not a medical provider under the statute, therefore, affirming the holding of the Board. The court reasoned that it would be unreasonable to conclude that, whereas here the employer was giving the claimant the ability to obtain the prescriptions as needed, the claimant could, nevertheless, refuse to do so and instead procure them from another pharmacy at a higher rate, which would then be more expensive to the employer.

Case Law Alert - 4th Qtr 2012