Wash. Admin. Code § 296-20-03015 – What steps may the department or self-insurer take when concerned about the amount or appropriateness of drugs prescribed for the injured worker?

(1) The department or self-insurer may take any or all of the following steps when concerned about the amount or appropriateness of drugs the worker is receiving:
• Notify the provider of concerns regarding the drugs such as interactions, adverse reactions, or prescriptions by other providers;
• Notify the provider when opioid prescribing is not in compliance with the department of health's (DOH) pain management rules, the department of labor and industries' (L&I) rules, the agency medical directors' group's interagency guideline on opioid dosing for chronic noncancer pain or L&I's guideline for prescribing opioids to treat pain in injured workers;
• Require that the provider send a treatment plan addressing the drug concerns;
• Request a consultation from an appropriate specialist;
• Request that the provider consider reducing the dose or discontinuing the drug and provide information on chemical dependency programs, if indicated;
• Limit the payment for drugs to one prescribing provider.
(2) If the provider or worker does not comply with these requests, the department or self-insurer may discontinue payment for the drug after adequate prior notification has been given to the worker and the provider.
(3) If the probability of imminent harm to the worker is high, as determined by the department's medical director, associate medical director or medical consultants, the department or self-insurer may require that the worker transfer care to another network provider.
(4) Other corrective actions may be taken in accordance with WAC 296-20-01100, Risk of harm.

[Statutory Authority: RCW 51.04.020 and 51.04.030. WSR 13-12-024, § 296-20-03015, filed 5/28/13, effective 7/1/13; WSR 00-01-040, § 296-20-03015, filed 12/7/99, effective 1/20/00.]