Date: November 15, 2021
The Chair adopted the New York Workers' Compensation Drug Formulary (Formulary) regulations in 2019, and later amended 12 NYCRR 323.3, to require payers to notify affected injured workers and health care providers that refills and renewals of prescription medication must conform to the Formulary within six months of the effective date of the regulation. Due to the COVID-19 pandemic, the compliance requirement was delayed until June 7, 2021, and payers were instructed to provide a notice to affected injured workers and health care providers on or before April 1, 2021. The Board required another notice be provided on or before May 1, 2021.
The Board has decided the date refills and renewals must comply with the Formulary will coincide with the launch of the first phase of its new business information system, OnBoard: Limited Release (OBLR). Because the timing of the OBLR launch has shifted, the date for concurrent refill and renewal compliance with the Formulary has not yet been established. OBLR is now expected to be released within the first quarter of 2022. The Board will announce the rollout date of OBLR, via a WCB Notification email, at least four weeks before launch.
To ensure that treating health care providers and injured workers have adequate notice to prepare for the new compliance date, payers must do the following on or before January 5, 2022:
- notify health care providers of any injured workers they are currently treating with non-Formulary medications so they can either change medications or submit prior authorization requests to continue using the non-Formulary medications; and
- notify injured workers (claimants) who are currently prescribed non-Formulary medications, so they can discuss medication options with their treating health care provider.
Health care providers and injured workers may sign up for WCB Notification emails to ensure that they are notified of the exact date for compliance.
Clarissa M. Rodriguez