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New York announces process for payers to access the Drug Formulary Prior Authorization System

by
Optum for Workers' Compensation
| Aug 06, 2019

The New York State Workers Compensation Board (WCB) has released information on how to access and use the Drug Formulary Prior Authorization System. This is a web-based application to support the new drug formulary. It will be accessible on the WCB website and medical portal. Once fully developed and functional, the electronic system will:

  • Permit providers to request prior authorization for non-formulary drugs
  • Offer a dashboard which will enable users to track and respond submitted requests
  • Include administrative features for contact information and maintenance

What’s next for payers?
In compliance with the drug formulary regulations, no later than September 1, 2019, payers will need to access the application, utilizing the web-based system to enter the contact information for both First and Second-level review entities. This information shall include an electronic mailbox for each identified entity, which will be used to facilitate requests and responses for First and Second-level review.

As a reminder, the contact for First-level review may be a payer or a PBM. And the contact for Second-level review must be the Medical Director of the payer.

How will the system work?
The system will be populated by the payer using each payer's existing eClaims Trading Partner information. Once the application becomes available, each payer’s administrator will be notified. The administrator must then log into the application using their NY.gov ID and password to identify their organization’s contacts, as outlined above.

Health data exchangeThe contact information for electronic mailboxes will be used by the system to automatically route provider prior authorization requests to the payer-designated contact. If a payer designates a PBM as their Level 1 contact, the PBM must register and identify their users, utilizing the online registration process that the WCB is developing before a payer can select them as the Level 1 contact in the administration web application.

The electronic mailbox address will also be used to route requests to a user-specific dashboard. Additionally, each payer must identify individuals within the organization to administer the workload, and reviewers to respond to requests.

Moving forward ― important to note
Updates about the system and the online formulary administration application and registration process will be posted on the WCB website, as information becomes available. We stress that the system is still being developed, and future information will impact future compliance processes.

We urge our clients to initiate discussions internally and with OWCA on the handling of requests for First-level review to ensure full compliance with this requirement that starts September 1, 2019. The OWCA Government Affairs Team will continue to monitor developments related to the drug formulary and will share any updates, as necessary.

Should you have any questions on this or any other public policy development topics, please contact the OWCA Government Affairs team at AskGovtAffairs@optum.com.


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