2020 Edition of Workers’ Compensation Pharmaceuticals: Prior Authorization and High Dollar Rejections Guide
White Paper Summary
The intent of this guidebook is to provide a resource for claims professionals that allows easy access to information on medications that have been rejected and provides possible alternatives to the rejected medications.
The guidebook also provides the most common indication for each medication when used in the workers’ compensation population. A list of medications that should be considered prior to the rejected medication (step therapy) is presented, along with a supporting rationale.
The claims professional can use this information when contacting the prescriber to determine if drugs on the list of alternatives have been tried. If the prescriber has attempted at least one of the other medications, the claims professional can feel more confident in approving the medication because the decision was supported with clinical evidence. If none of the alternative medications have been tried, the prescriber should be asked to consider trying one of the listed alternatives prior to prescribing the rejected medication.
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