WAC 296-20-03012   Where can I find the department's outpatient drug and medication coverage decisions?  The department's outpatient drug and medication coverage decisions are contained in the department's formulary, as developed by the department in collaboration with the Washington state pharmacy and therapeutics committee and the Washington State Medical Association's industrial insurance and rehabilitation committee.

     In the formulary, drugs are listed in the following categories:

     • Allowed

     Drugs used routinely for treating accepted industrial injuries and occupational illnesses, including those on the preferred drug list.

     Example: Nonscheduled drugs and other medications during the acute phase of treatment for the industrial injury or condition.

     • Prior authorization required

     Drugs used routinely to treat conditions not normally accepted as work related injuries, drugs which are used to treat unrelated conditions retarding recovery from the accepted condition on the claim, and drugs for which less expensive alternatives exist. For example: All drugs to treat hypertension require prior authorization because hypertension is not normally an accepted industrial condition. In addition, nonendorsing practitioners must obtain prior authorization for a nonpreferred drug when the category of drugs has a preferred drug.

     • Denied

     Drugs not normally used for treating industrial injuries or not normally dispensed by outpatient pharmacies.

     Example: Most hormones, most nutritional supplements.



[Statutory Authority: RCW 51.04.020, 70.14.050. 04-08-040, § 296-20-03012, filed 3/30/04, effective 5/1/04. Statutory Authority: RCW 51.04.020 and 51.04.030. 00-01-040, § 296-20-03012, filed 12/7/99, effective 1/20/00.]