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New York advances workers’ compensation drug formulary

by
Optum for Workers' Compensation
| Oct 18, 2018

The New York Workers’ Compensation Board (WCB) has published, in the state register and on the WCB website, notice of its second version of the proposed formulary rule and drug list. This notice was posted Wednesday, October 17, 2018, and continues formal efforts to develop a formulary which began in December 2017.

This second version maintains continuity with the original draft but provides new processes – worthy of closer review – relating to prescribing and dispensing medications impacted by the formulary rule. In this newly proposed version, the WCB outlines processes for handling specific drugs in various phases of treatment, maintains requirements for prior authorization on specific identified drugs and compounds, and outlines the application of the formulary to claims based upon the prescription being considered ― a new prescription or a renewal or refill of an existing medication. The newly proposed version outlines specific handling of perioperative medications and other drugs based on the phase of treatment. The proposed rule also clarifies the application of the formulary, providing a six-month lead-in time for all new prescriptions and a 12-month lead-in time for all refills and renewals.  

The newly proposed rule text can be found here: http://www.wcb.ny.gov/drug-formulary-regulation/Text-Part-441-drug-formulary.pdf

The revised drug formulary list can be found here: http://www.wcb.ny.gov/drug-formulary-regulation/NYS-drug-formulary.pdf

Review and comment urged before deadline

The WCB has not scheduled a public hearing on the second proposed version but is accepting comments for 30 days from the date of publication. We urge our clients and all impacted stakeholders to review the second proposed version of the rule and submit comments prior to the deadline by emailing them to the WCB at: regulations@wcb.ny.gov

Our government affairs team will continue reviewing the newly proposed version and may provide greater insight based upon their analysis.  Should you have any questions on the continued development of the New York workers’ compensation drug formulary, please reach out to our GA Team at AskGovtAffs@optum.com.


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