The Workplace Health, Safety and
Compensation Commission's implementation in June 2002 of an on-line
system for the adjudication of prescription drugs for work-related
injuries has proven to be a success. For the majority of injured
workers, pharmacists and physicians, the transition to the on-line
system has been smooth.
Feedback from physicians and pharmacists,
for the most part, has been positive. However, in consultation with
physicians, the following common issues were identified.
Exceptions
If a prescription is written for a drug not
covered in an injured worker's assigned formulary, the treating
health care provider "will be required to submit written
documentation supporting the relationship between the drug
prescribed and the compensable condition. The Commission's Form 8/10
should be used to report this information." (WHSCC Policy
HC-11-Drug Formulary)
The Commission's decision-maker and medical
officer will review the documentation and the treating physician may
be contacted by the medical officer prior to a final decision. Where
consultation with the treating physician is required, payment will
be approved in accordance with the telephone consultation fee.
Special authorization
For drugs prescribed and not contained in
any of the drug formulary profile descriptions, a special
authorization must be obtained from the Director of Health Care
Services. The treating health care provider must provide supporting
medical documentation. A specialist opinion may also be requested at
the discretion of the Director of Health Care Services. In such
cases, it will be the responsibility of the treating physician to
arrange the specialist referral and submit any subsequent reports to
the Director of Health Care Services. Decisions will be based on the
merits of the individual case, and approval will be given for a
period determined by the Director of Health Care Services. Special
authorization determinations will be communicated in writing to the
injured worker and the treating physician.
Questions concerning
specific medications
If physicians have any questions regarding
specific medications that are being considered for an injured
worker, please feel free to contact Dr. Lorri
Galbraith, Director of
Health Care Services, or any of the Commission's medical
officers.
Copies of the table of formulary profiles
with assigned drug classes can be obtained by contacting the
Commission's Health Care Services Department at 709-778-1108.
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