The Short Answer
Form 25P is an official North Carolina Workers' Compensation form called an "Itemized Statement of Charges for Drugs." You use it to request reimbursement for prescription medications and medical supplies you paid for out of pocket after a workplace injury. To get your money back, complete the form in full, attach all receipts, and send it to your workers' compensation adjuster — or give it to your workers' compensation attorney who will forward it on your behalf. Once the adjuster reviews everything, they'll issue you a reimbursement check.
When you are involved in an accident that occurs on the job, there are a number of necessary Worker’s Compensation forms that need to be completed and then submitted to the appropriate office. One of these forms is called a 25P. Form 25P is also referred to as an “Itemized Statement of Charges for Drugs.”
This form is needed to obtain reimbursement for prescription or medical supply expenses related to the on the job injury and is also required under the Provisions of the Workers’ Compensation Act.
The form must be completed in its entirety and prescription and/or medical supply receipts must be attached. The completed form and the receipts should then be sent to the workers’ compensation adjuster or your workers’ compensation attorney who can provide them to the adjuster. The adjuster will then issue you a reimbursement check.
Key Takeaways
- Form 25P is the required NC Workers' Compensation form for recouping prescription drug and medical supply costs tied to a workplace injury.
- The form must be filled out completely — partial submissions will not be processed.
- You must attach all original prescription and medical supply receipts to the form before submitting it.
- Send the completed form and receipts directly to your workers' compensation adjuster, or route them through your workers' comp attorney.
- Submitting this form is required under the provisions of the NC Workers' Compensation Act, not just a recommended step.
- Once the adjuster approves the submission, they will issue a reimbursement check directly to you.
