CA Workers’ Compensation formulary in effect
Physicians were required to provide a plan for replacement and weaning of previously prescribed drugs inconsistent with the MTUS and Formulary by April 1, 2018. Anthem monitors “quality” pursuant to §9767.3(d)(8)(S) of the MPN regulations for MPN clients/payors.
California Code of Regulations Section 9792.27.3. MTUS Drug Formulary Transition
(b) (1) For injuries occurring prior to January 1, 2018, the MTUS Drug Formulary should be phased in to ensure that injured workers who are receiving ongoing drug treatment are not harmed by an abrupt change to the course of treatment. The physician is responsible for requesting a medically appropriate and safe course of treatment for the injured worker in accordance with the MTUS, which may include use of a Non-Exempt drug or unlisted drug, where that is necessary for the injured worker’s condition or necessary for safe weaning, tapering, or transition to a different drug.
The DWC Formulary Regulations are available here: http://www.dir.ca.gov/dwc/DWCPropRegs/MTUS-Formulary/MTUS-Formulary.htm
The Drug List is available here: http://www.dir.ca.gov/dwc/DWCPropRegs/MTUS-Formulary/Final-Regulations/DRUG-LIST.xls
The DWC provides an email address for questions regarding the formulary: firstname.lastname@example.org
August 2018 Anthem Blue Cross Provider Newsletter - California