New York adopts Drug Formulary changes – implements additional delays

September 2, 2021 · Public Policy & Regulatory Affairs Team

The New York Workers’ Compensation Board (WCB) has published a final rule adopting changes to the drug formulary. While the rule was posted on and effective September 1, 2021, an announcement states changes will be deferred to coincide with the launch of OnBoard: Limited Release, the first phase of the WCB’s new business information system. The WCB indicates it will provide all system stakeholders a four-week advance notification of when OnBoard-Limited Release will be implemented.
The newly adopted final rule includes the following changes to the existing formulary:

Provides an update to the formulary drug list – effective April 1, 2021
Sets a new effective date for application of the drug formulary requirements – September 13, 2021 – to “legacy claims” that are still receiving “refills and renewals” of their medications
Clarifies that the prior authorization process for medical marijuana will no longer be submitted via the existing paper variance request process but will be submitted via OnBoard – Limited Release as a “medication PAR”

It is important to note key effective dates in the adopted final rule:

September 1, 2021 - Utilization of the updated formulary drug list and prior authorization processes for medical marijuana
September 13, 2021 - Application of drug formulary requirements on “refills and renewals
TBD - Per the WCB, changes adopted in the final rule are delayed until final implementation of the OnBoard – Limited Release system

The final rule modifies Title 12 NYCRR Sections 441.1, 441.2, 441.3 and 441.5, which encompass the New York Drug Formulary.