441.2 New York Workers’ Compensation Formulary

The New York Workers’ Compensation Formulary, [1st] second edition ([January 23] November 5, 2019), incorporated by reference herein, identifies drugs using three lists: a) Phase A for prescriptions within the first thirty days following a Accident or injury; b) Phase B for prescriptions after, the sooner of, the first thirty days following a Accident or injury or acceptance or establishment of the claim; and c) Perioperative for use during the Perioperative period. Copies of the Formulary may be downloaded from the Board's website free of charge. The Formulary may be examined at the office of the Department of State, 99 Washington Avenue, Albany, New York 12231, the Legislative Library, the libraries of the New York State Supreme Court, and the district offices of the Board, or obtained from the Board by submitting a request in writing, with a fee of five dollars, to the New York State Workers' Compensation Board, 328 State Street, Schenectady, New York 12305-2318. Payment of the fee shall be made by check or money order payable to "Chair WCB." Information about the Formulary can be requested by email at [email protected], or by telephone at 1-800-781-2362.

1. Statutory authority: Workers’ Compensation Law (WCL) § 13-p requires the Chair to adopt a drug formulary and provide for amendment to the formulary upon consideration of suggestions made by interested parties, and WCL § 117(1) authorizes the Chair of the Workers’ Compensation Board (Board) to adopt reasonable rules consistent with, and supplemental to, the provisions of the WCL.

2. Legislative objectives: The proposal seeks to modify the drug formulary based on review and consideration of suggestions made by interested parties as required by section 13-p of the WCL, and provide guidance on when certain prescription drugs do not appear in the Medical Treatment Guidelines, but would be helpful in treating injured workers.

3. Needs and benefits: Workers’ Compensation Law § 13-p required the Chair to consider suggestions made for changes to the formulary. The proposal contains an additional special consideration in response to feedback received, as the intent is for the drug formulary to evolve to better address the needs of injured workers. The proposal closes a gap to better provide necessary treatment to injured workers.

4. Costs: The only costs associated with this proposal would be the minor programming costs to incorporate the minimal changes to the formulary.

5. Local government mandates: The proposal does not impose any program, service, duty, or responsibility upon any county, city, town, village, school district, fire district, or other special district. However, a municipality or governmental agency that is self-insured is required to comply with the same rules required of insurance carriers.

6. Paperwork: The proposal does not impose any new reporting requirements.

7. Duplication: The proposal does not duplicate other regulatory initiatives.

8. Alternatives: An alternative would be to not update the formulary, but as the legislative objective is to consider the suggestions of interested parties and the Board has considered the suggestions and finds them to be meritorious. Accordingly, not updating the list is not advisable.

9. Federal standards. There are no applicable Federal Standards.

10. Compliance schedule: All affected pharmacies, carriers, and self-insured employers will have to comply with the prescription drug formulary by December 5, 2019 for new prescriptions and June 5, 2020 for renewals.

A Regulatory Flexibility Analysis is not required because the proposal will not have any adverse economic impact or impose any reporting, recordkeeping or other compliance requirements on small businesses or local governments. The proposal provides guidance about which drugs may be used to treat injured workers, which will not have any adverse impact on small businesses or local governments.

A Rural Area Flexibility Analysis is not required because the proposal will not have any impact rural areas. The proposal provides guidance about drugs that may be used to treat injured workers. The amendment will not affect rural areas in any manner.

A Job Impact Statement is not required because the proposal will not have any impact on jobs or employment opportunities. The proposal provides additional guidance for drugs not included in the MTGs and will not affect jobs or employment opportunities in any manner.