Cal. Code Regs. Tit. 8, § 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.
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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