WAC 296-20-03023   When may the department or self-insurer deny payment of opioid medications used to treat chronic, noncancer pain?  Payment for opioid medications may be denied in any of the following circumstances:

     • Absent or inadequate documentation;

     • Noncompliance with the treatment plan;

     • Pain and functional status have not substantially improved after three months of opioid treatment; or

     • Evidence of misuse or abuse of the opioid medication or other drugs, or noncompliance with the attending physician's request for a drug screen.



[Statutory Authority: RCW 51.04.020 and 51.04.030. 00-01-040, § 296-20-03023, filed 12/7/99, effective 1/20/00.]