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When a PACIF member employee experiences a workplace injury, it's ideal for the supervisor to fill in and sign a print of this First Fill Prescription Form and give it to the injured employee before the employee seeks medical treatment. That way, if the injured employee is prescribed medication that's eligible for First-Fill coverage, they can get the prescription without having to pay for it with their own money. We encourage having every supervisor print several copies of this form, keep some handy in every work area, and know how to follow this procedure whenever possible.

This form is to be used for medications prescribed at an injured worker’s initial medical visit. If the employee is found to be entitled to workers’ compensation benefits and needs further medications, a Prescription ID Card will be provided. Following the recommended processes can help keep overall workers’ compensation costs down.

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