Workers’ Compensation Board Changes How Medications and Surgeries are Approved

On December 5, 2019, the New York State Workers’ Compensation Board (WCB) announced what they call a “drug formulary.” This formulary is basically a list of medications that can be prescribed to injured workers without prior authorization from the WCB. The medications are listed based on their effectiveness and appropriateness for the treatment of injuries and illnesses that occurred on the job. The formulary splits medications into three categories based on when and for how long they may be prescribed: Phase A, Phase B, and Perioperative. Click here to see a pdf created by the WCB with more details including the full lists of medications.

While the intent of the formulary is to make the prescribing process more efficient, just the opposite can happen if your health care provider is not familiar with the new guidelines. If you are being treated for an injury covered under Workers’ Comp, we strongly recommend that you have a conversation with your medical provider at your next appointment regarding the formulary and how it relates to your treatment.

Your doctor will also need to follow new guidelines for prior authorizations if they want to prescribe you medication that is not listed on the formulary, is a brand name medication when a generic is available, or is a compound drug. If your medication is denied by the WCB, your provider can request a review. Depending on the denial, the final decision regarding your medication may be determined by the NYS Medical Director. Unfortunately, this limits what we are able to do during the denial process other than reaching out to your provider.

In addition to the drug formulary, the Workers’ Compensation Board also adopted a newly created online medical portal. Doctors will now be responsible for uploading prior authorization information for medications and surgeries into the portal for approval. The goal of the portal is to make the process more efficient. However, we believe these procedures may be intended to further limit your rights to medical care and it is important that your doctor be up to date so that your care is not interrupted.

For more information on the WCB drug formulary and the medical portal, you can visit the NYS Workers’ Compensation Board website. If you and your doctor have problems navigating these new systems, please contact us so that we can assist you in obtaining the medical care you need and deserve. We also invite you to visit our website to learn more about the team who will help you

Segar & Sciortino has served Western New York for more than 25 years in the areas of Workers’ Compensation, Social Security Disability, and Personal Injury (Accident) Law. Our team will look at your case from every angle to help you get all of the benefits you deserve.

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