Cal. Code Regs. Tit. 8, § 9792.27.13 - Mtus Drug List - Perioperative Fill
(a) The MTUS Drug List identifies drugs that
are subject to the Perioperative Fill policy. Under this policy, the Non-Exempt
drug identified as a Perioperative Fill drug may be dispensed to the injured
worker without seeking prospective review if all of the following conditions
are met:
(1) The drug is prescribed during
the perioperative period; and
(2)
The prescription is for a supply of the drug not to exceed the limit set forth
in the MTUS Drug List; and
(3) The
prescription for the Perioperative Fill -- eligible drug is for:
(A) An FDA-approved generic drug or single
source brand name drug, or,
(B) A
brand name drug where the physician documents and substantiates the medical
need for the brand name drug rather than the FDA-approved generic drug,
and
(4) The drug is
prescribed in accordance with the MTUS Treatment
Guidelines.
(b) For
purposes of this section, the perioperative period is defined as the period
from 4 days prior to surgery to 4 days after surgery, with the day of surgery
as "day zero".
(c) An employer or
insurer that has a contract with a pharmacy, pharmacy network, pharmacy benefit
manager, or a medical provider network that includes a pharmacy or pharmacies
within the MPN, may provide for a longer Perioperative Fill period or may cover
additional drugs under the Perioperative Fill policy pursuant to a pharmacy
benefit contract or MPN contract.
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.
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