5 Tips to Prepare for the NY State Workers' Comp Formulary

December 2, 2019 · Optum

Implementation starts December 5, 2019

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Update – Ensure all contact information is updated in the New York Medical and Drug Formulary Prior Authorization (PA) Portal. Providers and Payers should ensure the information in their file(s) is up to date including the contact information and email addresses for Administrator, Work-Load Administrator, and Level 1 and Level 2 Reviewers.

http://www.wcb.ny.gov/medicalportaloverview/

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Educate – All providers, adjusters, and pharmacies should take the time to educate themselves on the latest version of the drug formulary list, which contains a newly adopted special consideration #4. This will help streamline the understanding of which drugs require PA and which drugs do not require PA.

http://www.wcb.ny.gov/drug-formulary-regulation/NYS-drug-formulary.pdf

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Prepare – Providers, payers, adjusters and Level 1 reviewers should prepare themselves to answer questions regarding the PA process. You are certain to get calls from treating physicians and claimants regarding the PA process and medications.

http://workcompauto.optum.com/newyorkformulary

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Remind – Remind your adjusters of the coming formulary, and remind your Administrators, Work-Load Administrators, Level 1 and Level 2 Reviewers that requests for PA will soon be submitted. They should be prepared to review their portal dashboard and PA queue in a timely manner to prevent delays in requests for authorization.

http://www.wcb.ny.gov/content/main/hcpp/DrugFormulary/ny-wc-formulary-providers-faq.jsp

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Communicate – Keep open the lines of communication with all stakeholders, prescribers, claimants and your PBM partners.

Should you have any last-minute questions, please feel free to contact our Government Affairs Team at AskGovtAffairs@optum.com.