New York State Workers' Compensation Drug Formulary
What you need to know about the NY State Drug Formulary
In May 2019, the New York Workers’ Compensation Board (WCB) filed an adopted list of approved medicines that doctors should prescribe when treating a New York workers’ compensation claim. This list of approved medicines is called a Formulary. This Formulary will take effect in two Phases.
- Phase 1: On December 5, 2019, the Formulary takes effect on any NEW medicines you are prescribed on or after that date for your work-related injury or illness.
- Phase 2: On January 1, 2021, the Formulary will take effect on your current, ongoing medicines for your work-related injury or illness.
If medicines to treat your New York workers’ compensation claim are on the approved Formulary list, then your medicines will process and be received as normal.
If medicines to treat your New York workers’ compensation claim are NOT on the approved Formulary list, authorization to process them is needed and that requires a conversation between your doctor and the claims professional handling your workers’ compensation claim.
I received a letter about my workers’ compensation medicines, now what do I do?
You received a letter from the company handling your workers’ compensation claim because you are currently prescribed medicines that are NOT on the approved New York Drug Formulary list. Take this letter with you to your next workers’ compensation doctor visit to discuss your medicines. Using their clinical judgment and your current recovery status, your doctor may decide to:
- Discontinue the non-formulary medicine
- Switch it to a Formulary approved medicine
- Continue your medicine as is
If they continue the non-Formulary medicine or prescribe new non-Formulary medicine for your claim, they are required to speak with the claims professional handling your workers’ compensation claim and follow the process to request Prior Authorization. Your workers’ compensation doctor will also receive a letter with your non-Formulary medicine information.
What medicines are on the New York Formulary?
The medicine list for the New York Formulary can be found here
In response to COVID-19, the New York State Workers' Comp Board modified the New York Workers' Comp Drug Formulary regulation to extend the prior authorization for renewals of non-formulary medications deadline from June 5, 2020, to January 1, 2021.