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New York adopts workers comp formulary

New York

The New York Workers’ Compensation Board on Wednesday formally adopted its drug formulary and prescribing rules for injured workers, set to go into effect Jan. 5, 2020.

The formulary includes a comprehensive list of requirements for prescribing and mandated reviews for drugs, with controlled substances such as opioids and muscle relaxants falling in the category of “special consideration” drugs. These drugs may not exceed a seven-day supply on the first fill, and preauthorization is required for all drugs in this category, according to the rules attached to the formulary.

Brand-name drugs, compound drugs and any drugs not listed on the formulary will also require a preauthorization at the time of prescribing. Payers can refuse to pay for drugs that are not preauthorized, the rules state.

The rules also call for insurers and self-insured businesses to provide two levels of preauthorization review: one to the payer and a second review to a medical professional if the physician objects to the outcome of the first review, according to the rules.

As for injured workers on drugs not listed on the formulary, the insurer or self-insured employer now has six months to “identify all claimants with current prescriptions for (such drugs) and provide written notification to the claimant and to the prescribing medical provider,” the rules state.

The drug list may be updated annually, the board documents state.


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