Overview

Legislation enacted in April 2017 required the New York Workers' Compensation Board to establish a drug formulary. The New York Workers' Compensation Drug Formulary (Drug Formulary) is based on a medication's effectiveness and appropriateness for the treatment of illnesses and injuries covered under the Workers' Compensation Law. Full information about the Drug Formulary can be found at New York Workers' Compensation Drug Formulary.

To support the Drug Formulary, a prior authorization process for requesting non-Formulary drugs was developed and includes a three-level review process:

• Level 1 Review - is performed by the payer and can be delegated to a Pharmacy Benefit Manager (PBM).
• Level 2 Review - must be the Carrier’s physician. Please see Subchapter M of Chapter V of Title 12 of NYCCR Part 441.1(g) for the definition of the Carrier’s Physician.
• Level 3 Review - is performed by the Board’s Medical Director’s Office.

The Drug Formulary Prior Authorization Request process has been replaced by OnBoard and is now a Medication PAR. Note: The Drug Formulary Prior Authorization application will be available in read-only mode effective March 7, 2022, to allow access to previously submitted requests. All previously submitted medication prior authorizations can also be viewed in the claimant's eCase folder.

Learn more about OnBoard.

The payer is responsible for designating and maintaining the Level 1 and Level 2 review contact information. This maintenance will be performed using the Board’s Medical Portal Online Administration application.

Learn more about Medical Portal Access and Administration.

Resources

• Drug Formulary – 03/07/2022 (Current Version)
• Subject Number 046-1498 (February 8, 2021) – Adoption of Consensus Amendments to 12 NYCRR 441.2 (Drug Formulary Technical Changes)
• Subject Number 046-1475 (November 15, 2021) – New York Workers' Compensation Drug Formulary Refills and Renewals Compliance Notification
• Provider Formulary Notification
• Injured Worker Formulary Notification
• Quick Guide to the Drug Formulary
• Drug Formulary Frequently Asked Questions (04/07/22)

Contact

General questions about the Drug Formulary should be sent to WCBFormularyQuestions@wcb.ny.gov.

Technical questions on the PBM Drug Formulary Access process can be directed to WCBTechnicalSupport@wcb.ny.gov.