Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 5.5.2. Medical Treatment Utilization Schedule

§ 9792.27.2. MTUS Drug Formulary; MTUS Drug List; Scope of Coverage; Effective Date.

(a) Drugs prescribed or dispensed to treat a work related injury or illness fall within Labor Code section 4600 's definition of “medical treatment” and are subject to the relevant provisions of the MTUS, including the MTUS Treatment Guidelines, provisions relating to the presumption of correctness, and the methods for rebutting the presumption and for substantiating medical necessity where the MTUS Treatment Guidelines do not address the condition or injury.

(b) Except for continuing drug treatment subject to section 9792.27.3, subdivision (b), a drug dispensed on or after January 1, 2018 for outpatient use shall be subject to the MTUS Drug Formulary, regardless of the date of injury.

(1) A drug is for “outpatient use” if it is dispensed to be taken, applied, or self-administered by the patient at home or outside of a clinical setting, including “take home” drugs dispensed at the time of discharge from a facility. “Home” includes an institutional setting in which the injured worker resides, including but not limited to, an assisted living facility.

(2) The MTUS Drug Formulary does not apply to drugs administered to the patient by a physician. However, the physician administered drug treatment is subject to relevant provisions of the MTUS, including the MTUS Treatment Guidelines.

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).