California Code of Regulations
Title 8 - Industrial Relations
Division 1 - Department of Industrial Relations
Chapter 4.5 - Division of Workers' Compensation
Subchapter 1 - Administrative Director-Administrative Rules
Article 5.5.2 - Medical Treatment Utilization Schedule
Section 9792.27.5 - Mtus Drug Formulary - off-Label Use

(a) Off-label use of a drug shall be in accordance with the MTUS Treatment Guidelines and rules and the MTUS Drug Formulary.

(b) Authorization through prospective review is not required to dispense an Exempt drug for an off-label use if the MTUS Treatment Guideline recommends the off-label use of the drug to treat the condition.

(c) Authorization through prospective review is required prior to dispensing the following drugs for an off-label use:

(d) When a physician believes it is medically necessary to prescribe a drug for an off-label use not recommended by the MTUS Treatment Guidelines or not addressed by the MTUS Treatment Guidelines, the permissibility of the treatment outside of the guidelines is governed by section 9792.21 subdivision (d) (condition not addressed by MTUS or seeking to rebut the MTUS), section 9792.21.1 (medical evidence search sequence), section 9792.25 (quality and strength of evidence definitions) and section 9792.25.1 (MTUS methodology for Evaluating Medical Evidence).