Delaware's workers' compensation pharmacy rules use a preferred drug list. When a prescriber wants an injured worker to get a non-preferred or brand-name medication, this one-page justification lets the pharmacist dispense it. It asks whether the prescription monitoring program was checked, the current or previous preferred drugs, the non-preferred drug selected and whether symptoms were controlled on the prior regimen.
The physician or other authorized prescriber completes and signs it, certifying compliance with the pharmacy regulations in 19 DE Admin Code 1341, section 4.13.
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Justification for Use of Non-Preferred Medication
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When a prescriber wants an injured worker to receive a non-preferred or brand-name drug instead of one on the Delaware workers' compensation preferred drug list. With the completed form, the pharmacist must dispense the selected medication.
It asks whether the prescriber has checked the Prescription Monitoring Program profile for the patient, with a yes or no answer. It also asks for the current or previous preferred medications, the non-preferred medications selected and whether symptoms were controlled on the prior regimen.
The prescriber gives it to the injured worker together with the prescription, and the worker hands it to the pharmacist. The prescriber signs a certification of compliance with 19 DE Admin Code 1341, section 4.13.