Cadence Rx Drug List

 The Cadence Rx Drug List is a comprehensive list of medications that are approved for use in treating work-related injuries and illnesses. This list is designed to ensure that injured workers receive effective and safe treatments while managing costs and preventing misuse of medication. This drug list provides a summary of medications that are covered and is not considered to be an all-inclusive list. Medications that are listed as non-formulary and those that are not listed are considered excluded medications, and will therefore reject at the pharmacy and require a prior authorization. Compliance with established drug lists is important to improve quality of care and control healthcare costs by ensuring appropriate clinical guidelines and relevant state-based regulations are followed accordingly.

INJURED WORKERS

The formulary is a list of medications that your workers’ compensation insurance covers for treating your work-related injury or illness. It’s designed to provide you with safe, effective, and affordable treatment options. These are the medications that are generally recommended first. They are chosen because they are effective and cost-efficient. Using these medications can help streamline your treatment and reduce delays. Whenever possible, your treatment will likely start with generic medications. We encourage you to talk to your prescriber about utilizing preferred generic treatments when medically appropriate.

Additional Information:

  • If your doctor prescribes a medication that isn’t on the drug list, they may need to get approval from your insurance company before you can receive it. This is called prior authorization and helps ensure the medication is necessary and appropriate for your condition

HEALTHCARE PROVIDERS

Your patient is receiving healthcare benefits through their workers’ compensation insurance. This plan includes a drug formulary that allows for preferred medications that are consider safe, effective, and likely related to the injury, to be covered under the patient’s injury. Prescribing these medications can help streamline approval processes and reduce delays in care.

Additional Information:

  • Generic medications should always be utilized first, when appropriate
  • Non-formulary or excluded medications will require a prior authorization to determine relatedness

FREQUENTLY ASKED QUESTIONS (FAQ)

Why is this drug list important?

This drug list is important because it provides information on medications commonly covered and clinically appropriate for common workers compensation injuries.

Who creates my drug list?

Your drug list is developed by clinicians and drug experts on the Pharmacy and Therapeutics Committee at Cadence Rx.

Where can I find the drug list and additional information?

You can access the drug list and additional information on the Cadence Rx website under Injured Worker Resources.

How do I obtain medications that aren’t on this list?

For medications not included on this list will require a prior authorization. Once the prescriber sends your prescription to the pharmacy and the pharmacy processes this prescription, Cadence Rx will automatically send the prior authorization to the adjuster, if required. For detailed instructions related to pending prior authorizations, please contact your adjuster.

Can I receive brand-name medications?

Generally, brand-name medications with generic alternatives require prior authorizations and review by the adjuster. Brand name medications with no generic alternatives may be dispensed without prior authorization if they are on the drug list. Generic medications for brand named drugs are preferred as they are cost-effective and provide the same therapeutic benefits.

Will my drug list ever change?

Yes, the drug list is subject to updates and review by the clinicians and drug experts on the Pharmacy and Therapeutics Committee at Cadence Rx to reflect the most current clinical and cost-effective options. Updated drug lists will be posted quarterly.