Key Takeaways:

• New York State Workers’ Compensation Board adopts Drug Formulary, effective for all new prescriptions December 5, 2019

• Formulary applies to all prescriptions following an accident or injury regardless of where the claimant resides

• Employers and insurers should notify claimants per Section 441.3(f) if their medical office prescribes Non-Formulary Drugs, formally raising an objection to usage and requesting alternate prescriptions

On June 5, 2019, the New York Worker’s Compensation Board promulgated regulations under 12 N.Y.C.R.R. 441 adopting a Drug Formulary. The New York State Workers’ Compensation Board Chair advises that the Formulary is designed to provide high-quality and cost-effective medications.

Under Section 441.3, the New York Formulary applies to all prescriptions following an accident or injury regardless of where the claimant resides. The Formulary becomes effective for all new prescriptions on December 5, 2019 and for all renewal prescriptions on June 5, 2020. The regulations allow drugs listed in the Formulary to be pre-authorized but most prescriptions remain subject to the New York Medical Treatment Guidelines. Any drug not listed in the Formulary will be considered a “Non-Formulary Drug” and require pre-authorization.

Goldberg Segalla’s Workers’ Compensation team is available to consult with clients on the applications and exclusions of the Formulary. We also advise clients to notify claimants per Section 441.3(f) if their medical office prescribes Non-Formulary Drugs, formally raising an objection to usage of any and all Non-Formulary Drugs and requesting that the medical office alter the prescribed medications to comply with the New York Formulary.

Click here to read the complete New York State Workers’ Compensation Drug Formulary.

 For more information, please contact:

• Debra L. Doby
• Damon M. Gruber
• Or another member of the Workers’ Compensation practice