First Fill Card: The Fast Pass for Workers' Comp Prescriptions
- Chris Cain, CWCP
- Aug 16
- 5 min read
When someone gets hurt on the job, the last thing they should be doing is standing in a pharmacy line, arguing over who’s paying for their meds. The First Fill Card is like a “fast pass” for that first prescription — it cuts through the paperwork, gets the injured worker what they need, and keeps the claim moving in the right direction. If your company isn’t using it, you might be making things harder (and more expensive) than they need to be.
What Is the Workers’ Comp First Fill Card?
The First Fill Card is a temporary prescription ID card issued to employees immediately after reporting a work-related injury. It enables them to fill a first prescription—typically up to 10–14 days supply or typically up to around $150—in-network pharmacies at no out-of-pocket cost, while their claim is being processed.
Eligibility & Who Uses It
Who qualifies? Any employee who suffers a compensable on-the-job injury. They receive the card once the employer’s insurer or third-party administrator (TPA) activates it, usually right after injury notification.
Do all employers need this?
No—use of a First Fill card is not compulsory. It depends on whether the workers’ comp insurance carrier or TPA provides this program as part of their managed pharmacy benefits.
Why Some Employers Don’t Use It
The program must be offered by the insurance carrier or PBM (Pharmacy Benefit Manager). If the insurer doesn’t partner with a PBM offering First Fill benefits (like Optum’s Tmesys, Mitchell ScriptAdvisor, Enlyte ScriptAdvisor), then the employer can’t use it.
Implementing First-Fill involves setup and coordination—some small employers or less proactive TPAs may simply not offer it.
How Employers Get Started
Confirm with your insurance carrier or TPA whether a First Fill program is available.
If it is, print or order temporary prescription cards and instruction sheets.
Train the supervisor or HR contact to fill out the card immediately upon injury and hand it to the employee.
Ensure employees know to take the card to participating pharmacies.
How Employees Get and Use It
Employee reports injury → gets a completed First Fill card from employer or supervisor.
They present the card at a participating pharmacy.
Pharmacist processes via PBM—employee pays nothing for that first fill, as long as injury claim is legitimate.
Frequency & Duration
The card is temporary—good for one-time, initial fill only.
Common limitations: 10-day supply (Encova), 14-day supply / typically $150 max (Matrix).
Validity generally between 7 and 30 days from date of injury.
What If the Pharmacy Doesn’t Accept It?
Pharmacies must be in-network. If one isn’t:
Employee or provider can call the PBM's help desk to locate a network pharmacy.
The insurance/claims examiner may help reimburse or direct to alternatives if necessary.
After the First Fill: Getting Work Comp Meds Afterwards
Once the claim is accepted, the employee receives a permanent pharmacy card for ongoing fills.
Further prescriptions follow normal comp claim processing through network pharmacies and PBM.
If coverage is denied or delayed, the employee may need to pay and then submit for reimbursement through insurer/claims examiner.
How Does the Employer Know Which Pharmacies Accept It?
The PBM typically includes major chains and many independents.
Employers/employees can:
Use a phone helpline or online locator tool provided by the PBM.
PBM may integrate locator into claims systems for adjuster use.
Brand vs Generic?
Generally, First Fill covers standard medications commonly used for workplace injuries—often generics but may include certain brand drugs based on utilization guidelines.
Controls are in place (e.g., drug utilization management) to ensure appropriateness and cost-effectiveness.
Pros & Cons
Pros | Cons |
Employee gets needed meds quickly and without upfront cost | Limited to initial fill only; capped duration/amount |
Employers control costs via PBM-managed utilization | Requires setup with carrier; not universally available |
Helps speed recovery and reduce complication risk | Pharmacy acceptance depends on network inclusion |
Reduces administrative burden vs manual reimbursements | If claim isn’t accepted, may revert to reimbursement process |
Employer Implementation: Carriers, Agents, or Business?
The First Fill program is part of the insurance carrier’s or TPA’s pharmacy benefit offerings, not a separate business you call independently.
Typically managed by a PBM like Optum, Enlyte, Mitchell, or Express Scripts.
Employers should work through the insurance carrier or agent to set up the program and request materials.
Many insurance agents are familiar with PBM-based programs, but knowledge varies—larger agencies are likelier to know and support it than smaller/generalist agents.
Cost & Premium Impact
Lower prescription cost management: PBMs negotiate better drug pricing; the First Fill card helps control early prescription expenditures.
Improved outcomes: Getting immediate meds can reduce complications, shorten disability duration, and possibly lower claims costs.
Potential premium moderation: Fewer medical delays and better claim outcomes may help contain overall comp claim costs, which in the long run could influence premium trends.
Final Thoughts
For employers looking to deliver quick, efficient support to injured workers:
Check with your carrier or TPA to see if they offer a First Fill pharmacy program.
If yes, get those temporary First Fill cards, train your HR or supervisor team, and include instructions for both employees and pharmacies.
Make sure employees know how to find participating pharmacies, and what comes next (permanent card, reimbursement, etc.).
Injured employees deserve fast access to their medication—no waiting, no confusion, no out-of-pocket hassles. The First Fill Card is a smart tool that delivers that help, streamlines claims, and puts you in control of early comp-medication spend. Let your insurer or agent know you’re ready to make it part of your playbook—and get your team the right meds, right away.
Bottom line — the First Fill card is one of those small, simple steps that can save you big headaches, keep costs in check, and show your employees you’ve got their back from day one.
Blog By: Chris Cain, CWCP | Host of Work Comp Chaos
ABOUT CHRIS
Current
Host of Work Comp Chaos | licensed in multiple states as both an insurance adjuster & agent
Vice President of The Southern Agency Insurance in charge of Daily Operations, and provides support to clients throughout their claims process.
United Heartland Insurance Company Claims Advisory Council
Speaking Events
Altaworld Insurance Tech & Innovation Conference: Q&A Discussion: The Role of Automation in Claims Processing - Reducing Fraud or Reducing Jobs?
Stairbuilders & Manufacturers Association: Hidden Liabilities
Georgia Public School Board Workers' Compensation Association: How To Handle Work Comp Claims
Homebuilders of Atlanta: Claims and Warranties
Lunch & Learn: Various Uses of Life Insurance - Key Man, Tax-Free Benefits, Buy-Sell Agreements
Prior
State of Tennessee Telehealth Advisory Committee assisting in developing rules and statutes
Utilization Review Advisory Committee
Past President of the Tennessee State Claims Association
Served 15 years as President of the Chattanooga Claims Association