New York has announced the implementation plan for the new drug formulary.
Which New York Cases Are Impacted?
This new drug formulary will effects ALL CASES and ALL CLAIMS in New York. It’s actually great news for employers because it limits the drugs that physicians can prescribe. Think of the drug formulary as a sort of companion/extension to the Medical Treatment Guidelines. The formulary is AUTOMATIC and MANDATORY. After December 5, 2019 payers can object to provider prescriptions which fall outside the formulary.
How Does the Formulary Benefit Payers?
The formulary should reduce employer/carrier costs by eliminating or reducing the following five (5) prescription types:
- A drug not listed on the Formulary,
- A Formulary brand name drug, when a generic is available,
- Combination products, unless specifically listed on the Formulary,
- A brand name drug when a generic version of the same active ingredient(s) is a commercially available in a different strength/dosage, or
- A compounded drug
WONDERING what’s in the formulary?
More good news: it’s short (12 pages) and available online here: https://www.wcb.ny.gov/drug-formulary-regulation/NYS-drug-formulary.pdf
Key Implementation Dates
There are TWO KEY DATES to know:
- DECEMBER 5, 2019: The formulary becomes mandatory in every case on December 5th! All prescriptions written on or after that date MUST FOLLOW the formulary.
- JUNE 5, 2020: The regulations (441.3) stated that all OLD prescriptions are void and as of 12 months form the effective date of the regulation (June 5, 2019) and therefore as of June 5, 2020 all drugs prescribed must follow the drug formulary.
Questions about the formulary?
Contact Greg Lois with any drug formulary questions you have regarding your New York workers’ compensation claims.