W. Va. Code R. § 85-20-55

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 85-20-55 - Drugs and Medications: Actions

55.1. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, may take any or all of the following steps when concerned about the amount or appropriateness of drugs the patient is receiving:

a. Notify the attending physician of concerns regarding the medications such as drug interactions, adverse reactions, prescriptions by other providers;

b. Require that the attending physician send a treatment plan addressing the drug concerns;

c. Request a consultation from an appropriate specialist;

d. Request that the attending physician consider reducing the prescription, and provide information on chemical dependency programs;

e. Limit payment for drugs on a claim to one prescribing doctor.

55.2. If the attending physician or worker does not comply with these requests, or if the probability of imminent harm to the worker is high, the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, may discontinue payment for the drug after adequate prior notification has been given to the worker, pharmacy and physician.

55.3. Physician failure to reduce or terminate prescription of controlled substances, habit forming or addicting medications, or dependency inducing medications, after the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, request to do so for an injured worker may result in a transfer of the worker to another physician of the worker's choice

W. Va. Code R. § 85-20-55