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PACIF members have access to a helpful form that can save injured employees from having to pay for an initial workers’ compensation prescription out of their own pockets. Although the First Fill Prescription Form is not a new process at PACIF, we suspect that a few important readers haven’t been introduced to it yet. Proper use relies on members being prepared before the form is needed and remembering to use it when a non-life-threatening injury occurs.  

What the Supervisor Should Do

  • As soon as possible, go to, hover over INSURANCE and down to I Need … , then hover to the right and, halfway down, click on a WC “First Fill” Prescription Form. Print several copies of this two-sided form. 
  • Put several blank copies of the form at every worksite, including in vehicles. 
  • When an employee is injured on the job, take one of these documents, fill in its “To the Supervisor” section, and give the form to the injured employee to have in hand at the initial medical evaluation. 
  • Be sure to submit the First Report of Injury as soon as possible (always within 72 hours). It’s easy to find at by hovering over INSURANCE, then down to File a Claim, and clicking to the right on First Report of Injury (Workers’ Compensation). 

What the Injured Employee Should Do

  • Receive from their supervisor a copy of the Express Scripts “First Fill” form filled in with the employee’s name, employer, and date of injury.
  • If the medical professional who first treats the injury prescribes a medication, the employee should give the “First Fill” form to the pharmacist. We suggest, though it is not necessary, to use a pharmacy listed on the back of the form.
  • Note that this form can only be used for the medications first prescribed to treat this specific reported workplace injury. The adjuster assigned to the claim will request a formal Prescription ID Card if further medications are indicated.

Please share this article with everyone in your organization who supervises employees. If they don’t already know how to follow these steps, they should start doing so immediately. Using it is a normal part of how Express Scripts, PACIF’s prescription partner, helps to streamline the claim process for injured employees. It also prevents mistaken payment of a workers’ compensation cost by the employee’s medical insurance, which can be time consuming to correct.  

PACIF members can pose any questions about using this form to or 802-262-1922, or to their claim adjuster. 

Peggy Gates, Manager
Workers’ Compensation Claims
VLCT Risk Management Services