Cal. Code Regs. Tit. 8, § 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.
Notes
Note: Authority cited: Sections 133, 4603.5, 5307.3 and 5307.27, Labor Code. Reference: Sections 4600, 4604.5 and 5307.27, Labor Code.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.