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

§ 9792.27.6. MTUS Drug Formulary - Access to Drugs Not Listed as an Exempt Drug on the MTUS Drug List.

(a) Drug treatment that is in conformity with the MTUS Treatment Guidelines is presumed correct on the issue of extent and scope of medical treatment pursuant to section 9792.21, subdivision (c), and Labor Code section 4604.5. Although the MTUS Drug List identifies Exempt drugs that do not require prospective review when dispensed in accordance with the MTUS Treatment Guidelines, other medically necessary drugs are available to the injured worker when authorized through prospective review.

(b) Any medically necessary FDA-approved drug, or nonprescription drug that is marketed pursuant to an FDA OTC Monograph, may be authorized through prospective review and dispensed to an injured worker if it is shown in accordance with the MTUS regulations that the drug is required to cure or relieve the injured worker from the effects of the injury. Determination of the medical necessity of treatment based on recommendations found outside of the MTUS Treatment Guidelines is governed by section 9792.21 subdivision (d) (condition not addressed by MTUS or seeking to rebut the MTUS), section 9792.21.1 (medical evidence search sequence), section 9792.25 (quality and strength of evidence definitions) and section 9792.25.1 (MTUS methodology for evaluating medical evidence).

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).