Life Sustaining Detox/Medication Reduction Guidelines

The purpose of this policy is to provide guidelines for appropriate implementation of the current Claims Drug Utilization Review Policy in claims that involve:

 

Ø  Continuation or termination of life sustaining drugs classes

Ø  Detoxification or medication reduction

Drug classes for conditions not allowed in the claim, for purposes of this policy, have been divided into two categories – those that are life sustaining and those that are not life sustaining.

 

Life sustaining drugs while not clearly defined, are those which, if not taken as prescribed could lead to serious health problems or death.  The following list of types of drugs is intended as a guide and is not a definitive list of life sustaining drugs.  The POR/ prescribing physician, in each case, must determine whether or not the drugs are to be considered life sustaining.

 

·         Anti-coagulant medications

·         Anti-rejection medications (organ transplants)

·         Cardiac medications

·         Hypertensive control medications

·         Hyperglycemic medications (Insulin)

·         HIV medications

·         Psychiatric medications

·         Pulmonary medications

·         Seizure control medications

 

Drug classes that are not deemed to be life sustaining, while perhaps beneficial for the patient, will not cause serious health problems or death if not taken as prescribed.

 

Drug classes are also reviewed to determine whether or not they are medically necessary and appropriate for the treatment of the allowed conditions in the claim, particularly at the current stage of injury.

 

Drug classes that fall into this category include those that are commonly prescribed during an acute phase of an injury, but have continued to be prescribed beyond the acute phase as the injury becomes chronic.  Examples of these types of drugs include:

 

·         Skeletal muscle relaxants

·         Narcotic and non-narcotic analgesics

·         Sedative-hypnotics

·         NSAIDs

 

Also falling into this category are drug classes that have been prescribed over a long period of time that have potential for causing dependency or addiction. Examples of these types of drugs include:

 

·         Narcotics/analgesics

·         Sedative-hypnotics

·         Benzodiazepines

·         Barbiturates

 

Drug utilization review – drug classes that are for the treatment of conditions not allowed in the injured worker’s claim.