Drug Formulary Advisory Comments

from the Tennessee Bureau of Workers' Compensation Medical Director
  1. Patients that are on long-term opioid medications from a pain management specialist deserve and require flexibility in the application of the Drug Formulary.
  2. If there are going to be delays in dispensing medications of over 72 hours, the patient and the prescriber should be notified by the pharmacy, pharmacy benefits manager (PBM) or adjuster immediately. Clear, accurate, current and complete contact information for the adjuster should be given to the patient and the prescriber if there are any delays caused by the prior approval process at the pharmacy or by the pharmacy benefits manager (PBM).
  3. In cases where long term psycho-active or opioid medications are being taken, enough medications (a minimum of 4 weeks) must be available to the patient if the prescriptions are submitted through the Utilization Review process. Clear and complete contact information for the adjuster must be given to the physician and to the patient.
  4. Adjusters must make available alternate contact information (if they are not going to be available) to the patient and to the prescriber in case a medical emergency occurs when these psycho-active or opioid medications are not approved or are delayed.