Key Takeaways

• The New York Workers’ Compensation Board has advised that  the OnBoard: Limited Release will be rolled out in three phases; the first beginning on March 7, 2022.

• Phase one requires that requests for medications—including medical marijuana—go through the prior authorization request process, replacing the Drug Formulary request process and
  MG-2/variance request process.

• Refills and renewals of medications must comply with the Drug Formulary as of the first phase on March 7, giving carriers the ability to further address claimant’s medications usage.

On February 3, 2022, the New York Workers’ Compensation Board announced that the OnBoard: Limited Release would be implemented in three phases, with the first effective March 7, 2022. The board also verified that, as part of the first phase, all refill and renewal medications should comply with the formulary by that date. Additionally, all requests for medication authorizations as well as requests for medical marijuana will have to go through the medication prior authorization request (PAR) process through the medical portal rather than the Drug Formulary process for medications or the MG-2/variance request for medical marijuana.

Leading Up to OnBoard: Limited Release

In 2017, legislation required the Workers’ Compensation Board to create and establish a drug formulary, and as of December 5, 2019, all new medications were required to comply with the formulary. The board indicated it would require refills and renewals of medications to comply with the formulary at a later date, but this date was repeatedly delayed due to COVID-19. As such, providers were able to continue to refill medications that did not comply with the formulary without any requirement to obtain authorization. The board advised the requirement for refills to comply would be effective at the same time as its OnBoard: Limited Release, its program to replace the paper-based filing system.

What Carriers and Administrators Should Do Now

Carriers and third party administrators need to make sure their current processes include reviewing the medical portal, including the PAR dashboard and PAR emails, to determine whether there are any outstanding requests. Failure to respond to requests timely can result in automatic approval of the request from the board. Additionally, as of March 7, 2022, if medications are being filled that are not listed on the formulary—whether it be a new medication or refill of a medication—our recommendation is to deny payment of the medication until the provider goes through the proper PAR process to obtain authorization.

The second and third phases of the OnBoard: Limited Release will include changes to the request for durable medical equipment, which will go into effect on April 4, 2022, and Treatment and Testing requests on May 2, 2022.

If you have any questions about these changes or the Drug Formulary in general, please contact:

• Danielle S. Engel
• Angela M. Pugliese-Ulmer
• Damon M. Gruber
• Sean J. McKinley
• Esther F. Omoloyin
• Or another member of our Workers’ Compensation group