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Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 5.5.2. Medical Treatment Utilization Schedule
New Query
§ 9792.27.10. MTUS Drug List; Exempt Drugs, Non-Exempt Drugs, Unlisted Drugs, Prospective Review.
(a) The MTUS Drug List is set forth by active drug ingredient(s).
(b) A drug that is identified as “Exempt” may be dispensed to the injured worker without obtaining authorization through prospective review if the drug treatment is in accordance with the MTUS Treatment Guidelines, except:
(1) Brand name drugs are subject to section 9792.27.7;
(2) Physician-dispensed drugs are subject to section 9792.27.8.
(3) Compounded drugs are subject to section 9792.27.9 even if one or more of the ingredients is listed as “Exempt” on the MTUS Drug List.
(c) For a drug that is identified as “Non-Exempt,” authorization through prospective review must be obtained prior to the time the drug is dispensed. Expedited review should be conducted where it is warranted by the injured worker's condition.
(d) For a drug that is identified as eligible for “Special Fill” or “Perioperative Fill”, the usual requirement to obtain authorization through prospective review prior to dispensing the drug is altered for the specified circumstances set forth in sections 9792.27.12 and 9792.27.13. If the requirements set forth in section 9792.27.12 or section 9792.27.13 are not met, then the drug is considered “Non-Exempt” and is subject to the provisions set forth under subdivision (c).
(e) For an unlisted drug, authorization through prospective review must be obtained prior to the time the drug is dispensed. A combination drug that is not on the MTUS Drug List is an unlisted drug even if the individual active ingredients are on the MTUS Drug List.
Note: Authority cited: Sections 133, 4603.5, 5307.3 and 5307.27, Labor Code. Reference: Sections 4600, 4604.5 and 5307.27, Labor Code.
HISTORY
1. New section filed 12-7-2017; operative 1-1-2018 pursuant to Government Code section 11343.4(b)(3) (Register 2017, No. 49).
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