In response to widespread health care industry challenges due to COVID-19, the Chair of the New York State Workers' Compensation Board (Board) has modified the New York State Workers' Compensation Drug Formulary (Drug Formulary) regulation (12 NYCRR 441.3(a)(2)) to extend the deadline by which all health care providers must obtain prior authorization for renewals of non-formulary medications from June 5, 2020, to January 1, 2021.
The six-month extension to January 1, 2021 will:
- Reduce the impact that the COVID-19 emergency may have on health care providers' ability to implement the requirement.
- Provide more time to health care providers to ensure that prescription renewals are consistent with the Drug Formulary.
- Ensure that the current health crisis does not negatively affect injured workers, especially those who are on certain medications that are non-formulary agents.
This extension also aligns with the expected implementation of the first phase of the Board's Business Information System (BIS) Project. In the first phase, the Board will roll out a new web-based portal through which providers can request and manage prior authorization and variance requests related to treating injured workers, taking common forms (MG-1, MG-2, and C4-Auths) and related processes online.
The new portal will promote greater access for health care providers, quicker response times for prior authorization requests, and greater system reliability - resulting in the improved delivery of care to injured workers.