New York State Workers’ Compensation Board Announces Drug Formulary and Medical Marijuana Clarification
Knowledge

New York State Workers’ Compensation Board Announces Drug Formulary and Medical Marijuana Clarification

Key Takeaways

  • Regulations regarding the New York State Workers’ Compensation Drug Formulary will be deferred from September 1, 2021, and coincide with the launch of OnBoard: Limited Release

  • Stakeholders will be provided with a four-week notification of the implementation of Onboard: Limited Release

  • At the time of the release, prior authorization requests for medical marijuana will no longer be submitted via the existing variance request form, MG-2.0, but will instead be submitted within the OnBoard: Limited Release as a medication prior authorization request

 

At the time of the launch of Onboard: Limited Release stakeholders (i.e., health care providers, medical suppliers, insurers, and third-party administrators), will be required to submit prior authorization requests for care, as well as a request for decision on unpaid medical bills via the OnBoard: Limited Release platform.

The Board has advised that medication prior authorization request (PAR) will also apply to medical marijuana requests. Thus, forms MG-2.0 will no longer be the accepted method for applying for authorization to prescribe medical marijuana. When OnBoard: Limited Release is launched, providers will submit requests through the OnBoard system by choosing “Medical Marijuana”  on the PAR submission screen and following the system prompts. The Board has provided guidance that the criteria for medical marijuana for approval will remain the same, however. Currently, insurers will be required to respond to any medication PAR within four calendar days.

To prescribe medical marijuana, four requirements of the Public Health Law 3360(7) must be met: (1) the New York State Department of Health accredits the physician to prescribe medical marijuana; (2) the claimant has one of the severe debilitating or life-threatening conditions set forth in Public Health Law 3306(7), which must be accompanied by one or more of the list complicating conditions; (3) the prescribing physician must certify the claimant as having one of the severe debilitating or life-threatening conditions and submit proof of such certification to the Board; and (4) the claimant must register with the Department of Health and receive a registry card, which the claimant must produce as proof of registration.

RECOMMENDATIONS

Insurers are recommended to monitor and calendar the implementation date of the OnBoard: Limited Release platform when the Board provides guidance as to the launch date. As noted above, the Board is providing a very limited timeframe to respond to medication PARs. Specifically, the insurer is required to respond within four days. Although the process will no longer be dictated by forms MG-2.0, the provider still has the four prong burden of proof under Public Health Law to meet for authorization. If this burden of proof is not met, the medication PAR may be denied by the insurer. Thus, insurers, third-party administrators, and self-insured employers are recommended to setup a comprehensive and well-organized system designed to specifically respond to medication PARs in a timely fashion to avoid authorization without a response from the insurer.

If you have any questions about these changes or how they impact your business, please contact: