Maximus Says Scrap UR, Go Straight to IMR for Disputed Drug Denials

The development of a model law for states seeking to adopt a workers’ comp drug formulary has sparked a debate over the role of utilization review in disputed drug requests. Maximus, a provider of independent medical review services, said that the “vast majority” of the time when an employer denies a requested drug, utilization review facilitated by the payer upholds the initial denial. Instead of the UR step, Maximus said, the injured worker should have the right to seek independent medical review of the denial. “A more streamlined, independent appeals process is nee...