As expected, the New York Workers’ Compensation Board (WCB) adopted an emergency amendment to the existing Drug Formulary rule. The change, as discussed on the various training webinars sponsored by the WCB, adds a “special consideration #4” to the Drug Formulary list.
Special consideration #4 provides for the prescribing and dispensing of formulary drugs when “there is no Medical Treatment Guideline (MTG) for a condition directly associated with an established or accepted body part, but not specifically addressed in the existing WC MTG.”
As a general example, certain respiratory medications listed on the New York Drug Formulary are intended to treat a specific lung condition known as pulmonary fibrosis. Prior to the adopted special consideration #4 these medications required prior authorization, due to no currently available New York MTGs specifically addressing pulmonary fibrosis. However, due to the adopted change, these and other medications will be permitted under Special Consideration #4 as a method to allow medications that would otherwise be blocked, due to a lack of available guidelines.
Formulary drug list changes
The emergency rule also contains changes to the formulary drug list as part of the emergency rule adoption, and these changes can be found in the new drug list at: http://www.wcb.ny.gov/drug-formulary-regulation/formulary-changes_20191105.pdf. Some of the broad changes that have been made include allowing antihistamines, laxatives and sedative hypnotics during Phase B, which were previously not allowed per the New York WCB Formulary.
Formal notice and comment period
Formal notice of emergency rule adoption will be published as of November 20, 2019 and the emergency rule will be effective for 90 days from the November 5, 2019 filing. Comments on the proposal will be accepted for 60 days and can be submitted via email at regulations@wcb.ny.gov.
Going forward
Our clinical team is currently working to understand and quantify the impact of this emergency adoption on our clients New York claims. As the implementation of the formulary is less than a month away, processes and procedures continue to evolve. OWCA’s Public Policy team will continue to monitor developments and we urge our clients to remain vigilant moving forward. If you have any questions on this or any other public policy development topics, please contact the OWCA Government Affairs team at AskGovtAffairs@optum.com.