Workers Compensation Pharmaceuticals: Prior Authorization and High Dollar Rejections Guidebook

2022 Edition

This guide provides information on some of the most commonly prescribed medications in workers’ compensation. The intent is to provide a resource for claims professionals that allows easy access to information regarding indications, generic availability, and possible alternatives.

Medications are listed alphabetically by generic name with the brand version beneath. This is modified from the industry standard of listing the brand version first to better reflect that the majority of drugs dispensed are now generic. The medication list, potential off-label uses, and possible alternatives are not exhaustive.

The myMatrixx clinical team is available to answer questions related to a patient’s medication regimen. In some instances, a recommendation may be made to conduct a One Drug Review or a more comprehensive Clinical and Safety Evaluation (CASE Rx)SM. Both of these products feature outreach to the prescriber to discuss the use of alternative medications and they may incur a charge.

This guide is not intended and should not be used or relied upon for the purposes of prescribing or using a product. It is solely for reference purposes. The trademarks and other product names listed in this guide are the property of their respective companies.