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Workers’ Compensation Board

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New York State
Workers' Compensation Board
328 State Street  Schenectady, New York 12305
Governor Andrew M. Cuomo

Subject No. 046-856

Board Proposes New Workers' Compensation Pharmacy Benefit Plan

Date: October 7, 2016

The New York State Workers' Compensation Board (Board) invites comments on a discussion document that proposes the creation of a new Workers' Compensation Pharmacy Benefit Plan.

The rapid pace of change in the pharmaceutical industry over the last few years has rendered the Board's pharmacy benefit structure inadequate to address the overwhelming number of new medications that have been introduced to the medical community. The Board's current pharmacy benefit describes reimbursement levels for brand, generic and compounded products, but otherwise provides little structure or guidance to prescribers. There is no drug formulary in place; no requirement for pre-approval/prior authorization; no process to ensure the appropriateness of prescribed medications.

Goals of a Pharmacy Benefit Plan

The overriding goal of a new Pharmacy Benefit Plan is to ensure that injured workers receive clinically appropriate, cost-effective medications as part of their medical care.

The proposed Pharmacy Benefit Plan outlined in the discussion document addresses multiple issues. It requires insurers provide Pharmacy Benefits Manager services, introduces a prescription drug formulary, imposes limitations on the prescribing of compounded medications, requires compliance with the Medical Treatment Guidelines prescription drug recommendations, and changes the reimbursement methodology.


The Board has published the Pharmacy Benefit Plan adobe pdf discussion document on our website. The purpose of this is to give interested stakeholders an opportunity to review and provide feedback on the proposal prior to any official action. We welcome your feedback. The Board asks that all comments be submitted via the supplied comment form: WCB Pharmacy Benefit Plan Comments, no later than November 14, 2016.


Kenneth J. Munnelly