New York Workers’ Compensation Board provides additional clarification on mandated drug formulary notifications

Optum for Workers' Compensation
| Aug 15, 2019

The New York State Workers’ Compensation Board (WCB) has released information on how to implement the mandated communications to claimants and their prescribers who will be impacted when the new drug formulary goes into effect in December 2019.

The adopted regulation stipulates that payers are required to notify claimants and their prescribing physicians about current medication therapies that will be impacted by the drug formulary implementation. The regulations specify that payers must notify medical providers and injured workers – no later than December 5, 2019 – that a currently prescribed drug is not a drug formulary approved medication.

WCB providing communication templates
To assist payers with these communications, the WCB has provided – on its website – two specific templates: one for prescribing physicians and the other for claimants. Each template includes required data elements which must be communicated, but does not specifically mandate that communications are exact replicas.
The prescriber template requires communication of:

  • Patient Name
  • Patient DOB
  • Medication Name
  • Date of Accident
  • WCB Case Number
  • Payer Case Number

The claimant template requires communication of:

  • Date of Prescription
  • Medication Name
  • Prescriber

The purpose of these communications is to remind both the prescriber and the claimant of a two-step timeline:

  • December 6, 2019: refills and renewals of ongoing prescriptions/treatments will not initially be impacted by the drug formulary
  • June 5, 2020: all prescriptions ─ regardless of renewal or refill status ─ will be subject to the drug formulary rules

The WCB website defines “refill” and “renewal” and clarifies how to handle ongoing narcotic/opioid therapies ― well in advance of the June 5, 2020 date.

Health data exchange

What’s required for payers?
The drug formulary regulations require that no later than December 5, 2019, payers must ensure they have sent a written communication to both prescribers and claimants currently utilizing a non-formulary drug. Payers should initiate discussions – as necessary – with their pharmacy partners about the processes necessary to ensure compliance with this requirement.

What OWCA is doing for clients
Optum Workers’ Comp and Auto No-fault (OWCA) is assisting clients by sharing data and information on impacted clients and prescribers, providing letter templates, and submitting these communications on behalf of our clients, if clients request this. We urge all clients to reach out to their account manager to initiate discussions.

Moving forward
As the New York Drug Formulary continues to evolve, the OWCA Government Affairs Team will continue to engage with the WCB. If you have any questions on this or any other public policy development topics, please contact the OWCA Government Affairs team at

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