Section 9792.27.13 - Mtus Drug List - Perioperative Fill(a) The MTUS Drug List identifies drugs that are subject to the Perioperative Fill policy. Under this policy, the Non-Exempt drug identified as a Perioperative Fill drug may be dispensed to the injured worker without seeking prospective review if all of the following conditions are met: (1) The drug is prescribed during the perioperative period; and(2) The prescription is for a supply of the drug not to exceed the limit set forth in the MTUS Drug List; and(3) The prescription for the Perioperative Fill -- eligible drug is for: (A) An FDA-approved generic drug or single source brand name drug, or,(B) A brand name drug where the physician documents and substantiates the medical need for the brand name drug rather than the FDA-approved generic drug, and(4) The drug is prescribed in accordance with the MTUS Treatment Guidelines.(b) For purposes of this section, the perioperative period is defined as the period from 4 days prior to surgery to 4 days after surgery, with the day of surgery as "day zero".(c) An employer or insurer that has a contract with a pharmacy, pharmacy network, pharmacy benefit manager, or a medical provider network that includes a pharmacy or pharmacies within the MPN, may provide for a longer Perioperative Fill period or may cover additional drugs under the Perioperative Fill policy pursuant to a pharmacy benefit contract or MPN contract.Cal. Code Regs. Tit. 8, § 9792.27.13
1. New section filed 12-7-2017; operative 1-1-2018 pursuant to Government Code section 11343.4(b)(3) (Register 2017, No. 49). Note: Authority cited: Sections 133, 4603.5, 5307.3 and 5307.27, Labor Code. Reference: Sections 4600, 4604.5 and 5307.27, Labor Code.
1. New section filed 12-7-2017; operative 1/1/2018 pursuant to Government Code section 11343.4(b)(3) (Register 2017, No. 49).