New Treatment Guidelines Take Effect on February 28, 2016

By Dr. Robert Snyder, M.D.

Treatment Guidelines (Work Loss Data Institute, ODG) have been adopted by the Tennessee Bureau of Workers’ Compensation. All interested and affected parties will now be able to access and use the same information for determining the medical necessity and appropriateness of recommended treatments. 

The guidelines are not a mandate but are a single, comprehensive set of evidence-based information to use for treatment considerations, including surgery, physical therapy, psychotherapy and other modalities. These may be used from now on to access information for treatment recommendations. Click here for subscription information. In addition to the treatment guidelines, the subscription version includes return-to-work tables, ICD-10 and CPT indices, cross-walks, documenting exceptions and cost calculators. Click here for an abbreviated, free version of only the treatment guidelines.

Drug Formulary

Part of the adoption of the Treatment Guidelines includes a Drug Formulary. This is part of the Appendix A in the ODG guidelines and will be posted on the Bureau’s website. This is designed to allow the proper use of classes of drugs where Workers’ Compensation needs more use of appropriate generic medications, and to limit those types of medications that have low evidence of efficacy. The Formulary requires certain medications to get prior approval before being dispensed.  

Not unlike other commercial or the Tenncare formularies, if the prescribing doctor allows an appropriate substitution, this will be made with no delay to the patients. There is a six-month phase-in period where notification of the newly-prescribed affected medications will be given to the patient and the doctor before the prior approval process will begin, giving everyone time to become familiar with it before the August 28, 2016 effective date. Medication refills for prescriptions written prior to January 1, 2016, will not be affected until February 28, 2017. Until these dates, there will be no change in the present way prescriptions for injured workers are written or dispensed. 

More details will be posted on the Bureau’s website as they become available. 

Dr. Snyder is Medical Director for the Tennessee Bureau of Workers’ Compensation.

If you are a subscriber of  workcompcentral, more information is available here.

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