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PDFWAC 296-20-03012

Where can I find the department's outpatient drug coverage decisions?

The department's outpatient drug 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 industrial insurance medical advisory committee.
In the formulary, drugs are listed in the following categories:
Drugs used routinely for treating accepted industrial injuries and occupational diseases, including those on the preferred drug list.
Example: Preferred nonsteroidal anti-inflammatory drugs during the acute phase of treatment for the industrial injury.
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.
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.
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 and 51.04.030. WSR 13-12-024, § 296-20-03012, filed 5/28/13, effective 7/1/13. Statutory Authority: RCW 51.04.020, 70.14.050. WSR 04-08-040, § 296-20-03012, filed 3/30/04, effective 5/1/04. Statutory Authority: RCW 51.04.020 and 51.04.030. WSR 00-01-040, § 296-20-03012, filed 12/7/99, effective 1/20/00.]
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