Pain Management Program Providers
June 18, 2013
Medication Approval and ATI Recommendations
1. Reminder regarding the process of medication approval for Workers
prescribed opioid or sedative-hypnotic medication
WorkSafeBC’s long-established policy is to cover the costs of opioid and sedativehypnotic medications for injured workers for up to 8 weeks post injury or post surgery.
Under special or extenuating circumstances, WorkSafeBC may cover the costs beyond
this acute period.
While opioid prescriptions continue to be covered for 8 weeks post injury or post surgery,
starting 2011, WorkSafeBC introduced a new practice for the reimbursement of
prescription sedative-hypnotics and other drugs in the benzodiazepine class.
Sedative-hypnotics
Sedative-hypnotics are generally prescribed for patients with sleep disturbances. For
WorkSafeBC to cover the costs of these prescriptions, their use must be directly related
to a compensable injury.
Where the injured worker is having difficulty sleeping as a direct result of a compensable
injury, WorkSafeBC may pay for sedative-hypnotic medication for up to 2 weeks post
injury or post surgery. WorkSafeBC does not pay for this class of medication to treat
sleep disturbances on a long-term basis.
In particular, WorkSafeBC does not reimburse for sedative-hypnotics used for chronic
pain or muscle spasm. Instead, we fund treatments that address the injured worker’s
underlying issues and compensable injuries.
There are exceptions where WorkSafeBC will consider reimbursement:
•
Compensable psychiatric conditions, such as PTSD, where the workers is under
the care of a psychiatrist
•
Preoperative or pre-procedure use of
prescription for 1-2 days will be covered
•
Spinal cord injuries-this class of medication will be covered to treat spasticity
associated with significant compensable spinal cord injuries.
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Prescriptions beyond WorkSafeBC’s time limits
For Injured Workers attending the PMP, new prescriptions for opioids beyond 8 weeks
post injury/surgery or sedative-hypnotics beyond 2 weeks post injury/surgery, must be
discussed with the Case Manager and approval obtained. Without Case Manager
approval, the prescribed medication would otherwise not be paid for by WSBC.
Workers should also be aware that opioids and sedative-hypnotic medications
prescribed prior to PMP admission will also be reviewed during PMP and per Policy and
Practice Directive, Case Manager’s approval will need to be obtained for ongoing
support of the prescriptions.
Please note that WorkSafeBC includes tramadol (Tramacet) in the list of controlled
opioids.
The complete Practice Directive may be accessed via the following link:
http://www.worksafebc.com/regulation_and_policy/practice_directives/compensation_pra
ctices/assets/pdf/C10-1.pdf
2. ATI Recommendations
It has recently been brought to our attention that several Discharge Reports from the
PMP Programs have included a recommendation for ATI (Adjustment to Injury)
treatment. ATI treatment is intended as a short-term treatment where the Injured Worker
needs a brief period of support to adjust to the injury and by definition should be an
unlikely recommendation following treatment in a PMP Program.
Recommendations for services such as ATI can have significant claims implications, in
particular when a claim is being considered for medical plateau. In general, please
ensure that all recommendations for new or ongoing treatment are approved by the
Claim Owner prior to including these in a report.
If you have any questions, please do not hesitate to contact us.
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