New York Workers’ Comp Board sets new drug formulary application date for prescription renewals and refills
On February 16, 2021, the New York Workers’ Comp Board (WCB) issued an update stating the Drug Formulary will be applied to renewals and refills beginning June 7, 2021
Prior to the COVID-19 pandemic, the WCB rolled out two phases of their new Drug Formulary. The first phase, now fully effective, applied Drug Formulary requirements on all new prescriptions on or after December 5, 2019.
Applying Drug Formulary requirements to refills and renewals was originally scheduled for June 5, 2020 to provide an adjustment timeframe for stakeholders. Later last year, amid COVID-19, the WCB delayed this application date to January 1, 2021, and then subsequently pushed this date out even further.
In its latest update, Subject Number 046-1371, the WCB states, “On or after June 7, 2021, all refills and renewals of prescriptions must use a Drug Formulary medication unless prior authorization has been obtained before the date of the refill or renewal.”
- A refill means any subsequent fill of a prescription when the number of refills is explicitly included in the original prescription.
- A renewal means a prescription that the injured worker has been taking, but for which there are no available refills.
The WCB notification specifies on or before April 1, 2021, payers must notify healthcare providers and injured workers of the new June 7, 2021 effective date. This new requirement is an addition to the initial 2019/2020 communication requirement. The WCB update stresses, “These notifications must be in the format prescribed by the Chair” and provides a link to their templates:
Guidance for ongoing opioid treatments, opioid prior authorization and tapering
The WCB indicates when a prior authorization request (PAR) is submitted to continue opioids beyond the recommendations contained in the WCB’s Non-Acute Pain Medical treatment Guidelines (MTG), the payer should not deny the PAR on the basis a prescription is not consistent with the Non-Acute Pain MTG. Instead, the payer should grant or partially grant the PAR, as this protects the claimant from the medical consequences of an abrupt stop of long-term prescriptions. In these cases, the WCB urges stakeholders to review the WCB weaning process as outlined in Subject Number 046-892 from 2016.
Our Public Policy and Regulatory Affairs (PPRA) and Operations teams are currently reviewing this policy change. We will be working to ensure full compliance with the new requirements and will be reaching out to clients soon regarding the revised communication requirements.
Should you have any questions regarding this policy update, please contact our PPRA team at OWCPolicyMatters@optum.com.