November 18, 2020
As you are aware, legislation was signed in 2017 that required the New York State Workers’ Compensation Board (Board) to establish a prescription drug formulary. After multiple public comment periods, the Board adopted the New York Workers’ Compensation Drug Formulary (Formulary) regulations in May 2019. These regulations required new prescriptions to comply with the Formulary by December 5, 2019, and refill prescriptions to comply by June 5, 2020. Due to the COVID-19 pandemic, the Board moved the date for refill compliance with the Formulary to January 1, 2021.
As with any formulary, providers must have a way to prescribe non-formulary agents to treat worker-specific issues. To accommodate that need, a prior authorization process, using the Board’s online Medical Portal, was implemented. To date, there have been nearly 40,000 requests by providers to use non-Formulary medications through the Medical Portal prior authorization process.
As the Board approaches the final step in Formulary implementation, refill compliance, it is taking some additional time to ensure that the Formulary and prior authorization process work for all stakeholders. Thus, the Board is temporarily suspending the January 1, 2021, date for refill compliance, and a new date (likely spring, 2021), will be announced soon. Between now and then, the Board will address feedback from providers and payers; make system and process improvements by aligning with the initial release of the Board’s new business information system, OnBoard; and continue outreach and education to key users.
In the meantime, if providers have any difficulty getting needed medications for injured workers, or if payers have questions, please reach out to the Board’s Medical Director’s Office at wcbformularyquestions@wcb.ny.gov.
A full description of the Formulary and the prior authorization process, including two sets of Q&As, are posted on the Board’s website . You are encouraged to review the Q&As as a reminder of associated prior authorization requirements and parameters.
To reiterate key points associated with the prior authorization process:
Thank you for your ongoing efforts to ensure injured workers in New York State receive the medical care they need.