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  1. #1
    Join Date
    Apr 2007
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    63

    Default Brand Name Medications

    My workers compensation claim was made in the State of: ca does the adjustor has the right to deny brand name medecation been requested by my treating dr.

  2. #2
    Join Date
    May 2010
    Posts
    607

    Default Re: Brand Name Medications

    Quote Quoting mark14 View Post
    My workers compensation claim was made in the State of: ca does the adjustor has the right to deny brand name medecation been requested by my treating dr.
    Not completely sure on your question.....I would have no problem with a generic drug...I had more problems when they refused to pay for a generic anti-seizure med......It was just cruel what they did to me over and over for years!

  3. #3
    Join Date
    Apr 2007
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    63

    Default Re: Brand Name Medications

    Any one can hlep me with this issue

  4. #4
    Join Date
    Oct 1971
    Posts
    5,168

    Default Re: Brand Name Medications

    Unless the physician specifies in writing no substitutions can be made, the pharmacy must provide generic drugs.
    It's part of the latest reforms to save money.

    https://www.cwci.org/document.php?file=4190.pdf

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  5. #5
    Join Date
    Apr 2007
    Posts
    63

    Default Re: Brand Name Medications

    Thank for all of you i do have one more question my adjustor keep denying my med.he will dent it first then sending to U.R. i was able to get a phine call recird between the adjustor and my dr. Nurse telling here this med .deny unless you it changed to cheaper med.can i file fir hearing .what is my chance .and what the can do in this case.thank you

  6. #6
    Join Date
    Oct 1971
    Posts
    5,168

    Default Re: Brand Name Medications

    Quote Quoting mark14 View Post
    Thank for all of you i do have one more question my adjustor keep denying my med.he will dent it first then sending to U.R. i was able to get a phine call recird between the adjustor and my dr. Nurse telling here this med .deny unless you it changed to cheaper med.can i file fir hearing .what is my chance .and what the can do in this case.thank you
    Without your doctor specifying brand name only, it would be a waste of time to fie for a hearing.
    Unless there's a medical reason for brand name meds, you have to accept generic or pay the extra cost for brand name.
    Talk to your doctor, see if there's a medical reason for him to prescribe brand name only, otherwise you'll have to accept what they offer.

    Why do you want brand name meds, there's no difference?

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  7. #7
    Join Date
    Apr 2007
    Posts
    63

    Default Re: Brand Name Medications

    Thanks tony my dr.did request brand name med.but adjustor deny it then he send it to UR.my under standing that the adjustor cant deney any medical request. I do have problem with none brand iam
    Allergic Side effect .to the filling material in this med.each time different company different filling materials .

  8. #8
    Join Date
    Oct 1971
    Posts
    5,168

    Default Re: Brand Name Medications

    mark14
    my under standing that the adjustor cant deney any medical request.
    Sure they can, they do it all the time - they can get away with it as long as they follow the proper procedures.
    If you don't have a lawyer, now's the time to retain one.

    Q. What is utilization review (UR) and why is it used for workers' compensation?
    A. UR is the process used by employers or claims administrators to determine if a proposed treatment requested for an injured worker is medically necessary. All employers or their workers' compensation claims administrators are required by law to have a UR program. This program is used to decide whether or not to approve medical treatment recommended by a treating physician.

    The UR regulations allow an employer to reduce the cost of physician review in UR by designing a "prior authorization" program within the employer's UR plan. (See below: About prior authorization.)
    DWC supports the establishment of UR best practices that allow claims administrators to approve appropriate levels of care for injured workers at the lowest possible levels within the claims organization, without having to send those requests for external physician review.
    https://www.dir.ca.gov/dwc/Utilizati.../UR_FAQ.htm#13

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  9. #9
    Join Date
    Jan 2007
    Location
    PA, but worked in NJ
    Posts
    822

    Default Re: Brand Name Medications

    Hi Mark, Im not completely sure if Cal's reforms under Gov Arnold contradicts the general rule which is once you take up residence in a different state after your claim has run its course you fall under the residing states rules, Airdale makes a great point in that generics work fine in many patients like himself as well as my. The only name Brand med I take comes from the manufacturer 3 months at a time "Lyrica" their is no substitute for this. Also in NJ after MMI the patient is responsible 4 all palliative care including pain management. If I were you the 1st thing I would do is see whose rules apply. Tony is also correct if the Dr is not willing to write name brand required on bottom line where is says to write it you MUST ACCEPT generic equivalent,you always want a GOOD relation with your Pharmacist because in many cases you may need to try several makers of the generic equivalent b4 you get the benefit you seek. Gook luck

    Where is Santa???

    BUG

    Quote Quoting mark14 View Post
    My workers compensation claim was made in the State of: ca does the adjustor has the right to deny brand name medecation been requested by my treating dr.

  10. #10
    Join Date
    Apr 2007
    Posts
    63

    Default Re: Brand Name Medications

    I.m.r .over turn UR denial for med. For how long this over tur good. For a year.for same med .can UR deny same mde .

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