When a Texas workers' compensation carrier denies preauthorization for a drug the injured employee was already taking that is excluded from DWC's closed formulary, the prescribing doctor or pharmacy can ask DWC for a medical interlocutory order (MIO). The order lets the drug continue while the independent review of the denial is pending. DWC approves or denies the request on the form itself.
The prescribing doctor or the pharmacy completes the request and signs the certification in Section V. A prescribing doctor must give at least the doctor's name, the employee's name and date of birth and the drug information; other boxes are filled if known.
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Medical Interlocutory Order Request - Continued Use of a Drug Previously Prescribed and Dispensed and Excluded from TDI-DWC's Closed Formulary
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No. The form's FAQ says DWC accepts written requests that contain all the elements required by 28 TAC 134.550(c). The form is the simplest way to include them, since its sections track those requirements, including the requester's certification and the carrier notification.
The form reminds requesters that in a life-threatening emergency, the injured employee should be advised to go to the emergency room. The MIO process is for continuing a previously prescribed drug while a preauthorization dispute is reviewed, not for emergency care.