New York continues rule-making activity for Drug Formulary and OnBoard

The New York Workers’ Compensation Board (WCB) continues its rule-making and communication efforts related to the Drug Formulary and the implementation of OnBoard and the modernization of processes to care for injured persons in New York. Recent proposed and adopted rules cov

• The execution of the new DMEPOS Fee Schedule and associated regulatory requirements
• The Prior Authorization Requests (PARs) that correspond to the DMEPOS Fee Schedule and treatments that vary from the Medical Treatment Guidelines (MTGs).

Proposed changes to Drug Formulary Regulatory Segments

Recently, the WCB proposed changes to various regulatory segments that house the Drug Formulary and formulary components. Some of the proposed revisions have been covered by adopted emergency rules – such as the date of formulary application to renewals and refills of prescriptions – and some are newly proposed changes. The recently proposed changes to the Drug Formulary rules offer the following:

• Update of the Drug Formulary list to the 5^th edition, which will be available on the WCB website
• Creation of a Drug Formulary email at WCBFormularyQuestions@wcb.ny.gov
• Permanent language setting the application date of the Drug Formulary on all renewals and refills as of June 7, 2021
• Requirement to conduct a First Level review of a prior authorization for medical marijuana in conformity with existing law
• Inclusion of specific data elements for a PAR request for treatment utilizing medical marijuana

The Notice of Proposed Rule Making was expected to be published in the New York State Register on March 31, 2021 and comments will be accepted at regulations@wcb.ny.gov for 60 days. 

Update on OnBoard

In a separate release, the WCB alerted stakeholders (payers, providers, DMEPOS suppliers and PBMs) to prepare for OnBoard Limited Release. The update included information on the new DMEPOS Fee Schedule and PAR requirements and the updating of information for PBMs and payers coming to the Drug Formulary. The release provides information on the following:

• How to secure access to the Medical Portal and update administration, manager and user accounts
• Medical Portal access for payers who can designate or maintain their required point(s) of contact and user roles for the handling of Drug Formulary and eventually other DMEPOS and medical PARs
• The new system and the roles and responsibilities of PBMs if they are the PAR review entity for the payer
• An upcoming webinar covering OnBoard: Limited Release scheduled for April 14, 2021 at 1:00 pm EST

All of this information can be found at http://www.wcb.ny.gov/medicalportal/

As the WCB continues to mature regulations, as well as policies and procedures around OnBoard and Limited Release, the Optum Public Policy and Regulatory Affairs team will continue to watch for developments.