Cal. Code Regs. Tit. 8, § 9792.27.5 - Mtus Drug Formulary - off-Label Use
(a) Off-label use of a drug shall be in
accordance with the MTUS Treatment Guidelines and rules and the MTUS Drug
Formulary.
(b) Authorization
through prospective review is not required to dispense an Exempt drug for an
off-label use if the MTUS Treatment Guideline recommends the off-label use of
the drug to treat the condition.
(c) Authorization through prospective review
is required prior to dispensing the following drugs for an off-label use:
(1) Non-Exempt drug, or
(2) Unlisted drug, or
(3) Exempt drug lacking recommendation in the
MTUS Treatment Guideline for the intended off-label use.
(d) When a physician believes it is medically
necessary to prescribe a drug for an off-label use not recommended by the MTUS
Treatment Guidelines or not addressed by the MTUS Treatment Guidelines, the
permissibility of the treatment outside of the 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).
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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