Will the department or self-insurer pay for a denied outpatient drug in special circumstances?
Some of the drugs that are routinely denied may be covered in special circumstances. Requests for coverage under special circumstances require authorization prior to treatment. Examples of drugs that may be covered in special circumstances include:
• Drugs and medications to treat unrelated conditions when retarding recovery;
• Special treatments for unique catastrophic injuries.
The department may require written documentation to support the request.
[Statutory Authority: RCW 51.04.020
and 51.04.030. WSR 00-01-040, § 296-20-03013, filed 12/7/99, effective 1/20/00.]