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Policy Matters Brief December 15, 2020

December 15, 2020 · Policy Matters team

Alaska workers’ comp fee schedule updated
The Alaska Division of Workers' Compensation adopted an updated medical fee schedule, effective January 1, 2021. The updated fee schedule revised the compounded and/or mixed drugs language stating that they are to be limited to medical necessity, adding they also must be:

  • FDA-approved combinations
  • Reimbursed at the lowest generic NDC for each specific drug.

The updated fee schedule also includes a reduction in fees for durable medical equipment, prosthetics, orthotics and supplies as well as revised TENS unit and hearing aid provisions. Conversion factors for surgery, radiology, anesthesia and ambulatory surgical centers were also reduced, among other changes.

New York WCB suspends drug formulary refill compliance
The New York Workers’ Compensation Board (WCB) has temporarily suspended application of drug formulary refill/renewal requirements, moving them from January 1, 2021 to an undetermined date.

When the drug formulary was adopted, the WCB included a split effective date with all new prescriptions subject to formulary requirements as of December 5, 2019 and all renewals or refills of ongoing therapy subject to formulary requirements as of June 5, 2020.

Early in 2020, due to COVID-19 and a concern for injured person access to their physicians to discuss possible changes to their medications, the WCB pushed back application of the formulary requirements for refills/renewals until January 1, 2021. Recently, the WCB announced the previously scheduled January 1, 2021 application has been temporarily suspended. More information on the ongoing drug formulary developments can be found here.

New York WCB offers glimpse of OnBoard system
As the New York Workers’ Compensation Board (WCB) moves forward with development and roll-out of their new comprehensive claims system, the WCB continues to provide ongoing information relating to the new OnBoard system.

Development of OnBoard is ongoing with an expected “limited release” version set for Spring/Summer of 2021. The first “limited release” of OnBoard will impact medical providers; durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) providers/vendors; and payers, as the WCB plans to move the current paper-based prior authorization process to an electronic process via OnBoard.

Once the “limited release” version is operational, medical providers offering treatment that deviates from the current treatment guidelines, or any DMEPOS that WCB indicates requires prior authorization, will be able to do so via OnBoard in an on-line electronic format and no longer be required to file/fax paper forms. This process is expected to operate in the same fashion as the current prior authorization format for non-formulary drugs.

The full extent of OnBoard, the electronic claims system replacing eCase, is expected to be operational no later than Summer 2023. The WCB debuted OnBoard during a set of educational webinars in late November and early December with more training sessions and webinars planned over the coming months. More information regarding the continuing development of OnBoard can be found here.

Washington workers’ comp formulary updated
The Washington Department of Labor and Industries (L&I) recently published changes to their state fund outpatient drug formulary, effective January 1, 2021. The updates include adding darifenacin ER, solifenacin, and new drug class R1O (Polycystic Kidney Disease Agent, Arginine Vasopressin Receptor Antagonists).

The state fund’s outpatient drug formulary is a list of therapeutic classes and drugs that are covered under L&I's drug benefit. Drugs or therapeutic classes listed on the formulary do not guarantee coverage and may be subject to specific L&I policy and determination of appropriateness for the accepted conditions.

Washington is a monopolistic state but also permits employers to self-insure their workers’ comp claims. Self-insured employers are generally required to authorize treatment in accordance with L&I rules. View other recent posts on our Policy Matters blog.

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