Document name

Medication Coverage

Document number

POL 11/2019

1. The Workers’ Compensation Act, 2013 (the “Act”) defines medical aid as “the provision of medical and surgical aid, of hospital and professional nursing services, of chiropractic and other treatment and of prosthetics or apparatus.” (Section 2(1)(v)). Medical aid, also referred to as health care, includes the provision of prescription and non-prescription medications necessary, appropriate and sufficient for the treatment of an accepted work injury.
2. The Act directs the Workers’ Compensation Board (WCB) to arrange to provide and/or fund health care that may be required as a result of a work injury and that the WCB considers necessary (Sections 19(1)(b), 31(1), 103(1) and 115(c)).
3. Any health care provider who provides health care services to a worker will provide WCB with any reports that are relevant to the injury for which compensation is claimed (Section 55).
4. The WCB is authorized to gather information needed to determine all matter or questions arising under the Act (Sections 20 and 25). This information may be disclosed to health care providers for the purpose of providing any health care or treatment that may be required as a result of a work injury.

1. The WCB has the authority to determine the necessity, appropriateness, and sufficiency of medical aid provided to workers including medications. WCB will ensure that workers receive appropriate medications that are required to effectively treat, or facilitate recovery from, an accepted work injury or disease.
    
2. To be reimbursed for medications, a worker must submit copies of receipts to the WCB. The WCB may also authorize a pharmacy or licensed producer/seller to direct bill the WCB.

Medications – General

3. The cost of a prescription medication (i.e., other than opioids, pharmaceutical cannabinoids or medical cannabis) will be covered if:
   1. It is prescribed by the worker’s treating health care provider.
   2. It is appropriate and needed to treat an accepted work injury or disease, and
   3. The use of the medication either:
      1. Corresponds to the indications listed in The Saskatchewan Formulary or The Compendium of Pharmaceuticals and Specialties, or
      2. It is approved by a WCB Medical Officer (MO) for off-label use (i.e., the use of a medication beyond what is indicated on the product label).
4. The WCB may also cover the costs of non-prescription medications, such as over-the-counter medications and alternative health products.

Opioids

5. An opioid, also referred to as an analgesic or narcotic, means a prescribed medication that acts on the central nervous system to decrease the sensation of pain (e.g., codeine, morphine, hydrocodone, or oxycodone).
    
6. The WCB will cover the cost of an opioid medication when prescribed:
   1. By the worker’s treating health care provider.
   2. In accordance with the guidelines of the College of Physicians and Surgeons of Saskatchewan’s General Principles of Appropriate Pain Management with Opioids, and
   3. For the treatment of pain only (i.e., for pain related conditions such as, but not limited to pre-operation situations, palliative care, chronic bowel conditions, opioid addiction treatment with methadone or suboxone, etc.).
7. The WCB will monitor claims for potential issues of drug overuse or abuse.
   1. The costs of a drug treatment program or strategy may be covered if it is determined that an addiction or dependency resulted from the treatment of an accepted work injury.

Pharmaceutical Cannabinoids and Medical Cannabis

8. Pharmaceutical cannabinoids refer to manufactured medications that are based on the active chemical components found in the cannabis plant (e.g., tetrahydrocannabinol (THC) and cannabidiol (CBD)). These are approved by Health Canada, have drug identification numbers (DIN) and have known strengths and recommended dose ranges.
    
9. Medical cannabis refers to forms of cannabis authorized to treat a medical condition and can only be obtained from a Health Canada licensed producer/seller. It is the non-pharmaceutical form of cannabis without a drug identification number (DIN) or a natural product number (NPN).
    
10. The WCB may approve, on a case-by-case basis, the use of pharmaceutical cannabinoids or medical cannabis to treat one of the following conditions where the condition is clinically associated with a work-related injury or disease or its treatment:
    1. Chronic neuropathic pain (i.e., pain caused by damage or disease affecting the somatosensory system).
    2. As a form of opioid harm reduction.
    3. Spasticity due to spinal cord injuries.
    4. Chemo-induced nausea and vomiting.
    5. Loss of appetite during cancer treatment or because of AIDS.
    6. Palliative end of life care.
11. The WCB may cover costs related to pharmaceutical cannabinoids or medical cannabis if all of the following requirements are met:
    1. The worker has a listed condition noted above and the condition is clinically associated with a work-related injury or disease or its treatment.
    2. The worker’s treating health care provider has authorized pharmaceutical cannabinoids or medical cannabis to treat the condition.
    3. Other lines of treatment have been tried and were not successful in treating the condition.
    4. In the opinion of the WCB MO, the pharmaceutical cannabinoid or medical cannabis recommended by the treating health care provider:
       1. Meets currently published guidelines for safe and effective use.
       2. Will benefit the worker’s medical condition related to the work injury or will facilitate their recovery, and
       3. Meets appropriate dosage and route of administration.
12. All requests for coverage of pharmaceutical cannabinoids or medical cannabis must be reviewed by a WCB MO and recommended for cost reimbursement.
     
13. Preference will be given to the approval of pharmaceutical cannabinoids (i.e., approved by Health Canada with drug identification numbers (DIN)) over medical cannabis.
     
14. If a pharmaceutical cannabinoid product is prescribed, it must also either:
    1. Correspond to the indication listed in The Compendium of Pharmaceuticals and Specialties, or
    2. Be approved by a WCB MO for off-label use.
15. If medical cannabis is authorized, the following requirements must also be met:
    1. A copy of the care provider’s written order or medical document must be provided to WCB, which will include clear administration and dosage guidelines.
    2. A copy of the licensed producer/seller’s invoice must be provided to WCB, which will include a description of the product and the amount/quantity.
    3. The product must:
       1. Be obtained from a Health Canada licensed producer/seller with whom the worker is registered (i.e., license holder authorized to sell to registered clients).
       2. Be oil drops or soft gels or capsules for oral administration.
       3. Clearly identify the proportion of the active ingredients (e.g., a tetrahydrocannabinol (THC) and cannabidiol (CBD) per cent ratio of 1:20), and
       4. Contain an appropriate per cent of active ingredients as approved by a WCB MO.
16. The WCB will not cover the costs where the worker obtains, or seeks to obtain, cannabis from any other source (e.g., designated production, personal production such as growing cannabis plants, or a recreational cannabis retailer).
     
17. The WCB may suspend or discontinue payment for medical cannabis where there is evidence it is no longer necessary, appropriate, or sufficient treatment.