What the 10880A is for
The Medication Exception Form asks WSIB to cover a medication for a work-related injury or illness that falls outside its formulary. WSIB considers non-formulary drugs case by case. For opioids, WSIB allows initial prescriptions of select drugs under 90 MED for up to 12 weeks, and every opioid above 90 MED needs authorization.
It is often confused with WSIB’s narrative drug utilization reports, which WSIB requests when it needs details of a person’s medication. The 10880A is the prescriber’s own structured request.
Who completes it
Only the prescriber completes it, usually the physician or nurse practitioner treating the work injury. Complete the first page, then Part A for a non-opioid request, Part B for an opioid request, or both. The patient has no part.
How to fill in the form
Patient information, signature and billing
Enter the claimant’s name and claim number, then your name, address, phone, service date, WSIB provider ID and invoice number. Tick the fee code for the part or parts you complete. Sign, or tick the electronic signature box and add your name and date.
Requested medication(s)
List each medication with dosage and frequency, the morphine equivalent dose for opioids, expected duration, and the work-related diagnosis it treats. Then tick which part you’re completing.
Part A: Non-opioid treatment requested
Explain why the medication is needed outside the formulary. For initial requests, list previously tried medications, including those contraindicated or not tolerated. State the goals of therapy and the clinical indicators that support continuing, including any plan to change the dose. Rate overall function in the past week from 1 to 10, tick the areas that improved, and list comorbidities, safety concerns and supporting results such as blood levels or urine screens.
Part B: Opioid treatment request
Say whether there’s an opioid treatment agreement, whether you recommended a naloxone kit, and whether you used the Opioid Risk Tool, with the score. Give the same rationale, trial history and goals as Part A, plus whether the MED increased and the patient’s average pain and function over the past week. Answer the safety questions on lost prescriptions, early renewals and unsanctioned dose escalation, list sedating medications such as benzodiazepines or gabapentinoids, and give a tapering plan if you’ve considered one.
Common reasons it’s delayed or declined
- No list of formulary alternatives tried, or why they aren’t suitable.
- Goals of therapy with no functional measure.
- An MED missing for an opioid.
- Part B without an opioid treatment agreement for long-term use.
- Concurrent sedating medications not listed.
- The wrong fee box ticked, or both ticked when only one part is complete.
Submitting and who pays
Submit the form at wsib.ca/submit, where you can upload it straight to the claim file, or fax or mail it to the numbers and address on the form. WSIB pays you the fee for each part you complete, so the patient isn’t billed.