The New York State workers' compensation drug formulary is complex and fast approaching. Our speakers will walk you through the formulary features, important dates to know, and detail IWP's internal workflow process.

1. Everything You Need to Know
New York State
Drug Formulary

2. Our Presenters
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Danielle Jaffee, Esq. is the Director of
Legal and Government Affairs with
Injured Workers Pharmacy and is a
licensed attorney in Massachusetts and
Connecticut. She has extensive
knowledge of health care, workers’
compensation, and pharmacy law with
years of multi-state lobbying
experience. Danielle is a graduate of the
University of Connecticut School of Law.
Neil Welch, PharmD is the Director
of Pharmacy with Injured Workers
Pharmacy. Neil oversees IWP’s
dispensing, clinical, and pharmacy
regulatory responsibilities of all 50
states. He received a Doctorate in
Pharmacy from Massachusetts
College of Pharmacy and Health
Sciences and holds a current
Pharmacist License in 20 states.
Michael Rocco Sposito, Esq. is the
Manager of Claims Operations with
Injured Workers Pharmacy. He is a
licensed attorney in Massachusetts
and specializes in the complexities of
litigated workers’ compensation
claims. Michael is a graduate of the
Massachusetts School of Law.

3. What is
the Drug
Formulary?
Part 441 of 12 NYCRR to
establish a drug formulary.
Unique to New York
Formulary drugs are selected based on a
“medication’s effectiveness and appropriateness
for the treatment of illnesses and injuries
covered.”
This drug formulary is essentially a list of
prescription drugs that do not require prior
authorization and is completely unique to
the state.
The New York workers’ compensation drug
formulary was adopted on June 5, 2019 by the
New York Workers’ Compensation Board (WCB).
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4. Drug Formulary Details
• Single effective date for all injuries
• Provider must seek prior authorization for:
• Non-formulary medications
• Formulary brand drug when generic is available
• Combination products
• Brand name drug when generic is commercially available in different strength/dosage
• Compound medications
• Opioid medications:
• Fills are limited to a 7-day supply during first 30 days following injury
• Refills/renewals of non-formulary opioids must get prior authorization
“well in advance of June 5, 2020”
• Divided into phases:
• Phase A
• Phase B
• Perioperative
• Adjusted for type of injury
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5. 5
DECEMBER 5, 2019
Newly prescribed medications
must be formulary medications.
Prior authorization required for
new script for non-formulary
medications.
JUNE 5, 2020
Refills and renewals are
subject to drug formulary.
Prior authorization required
before date of refill or
renewal.
Refill: Subsequent fill of a prescription when the number of refills is explicitly indicated in the original script.
Renewal: Prescription that the injured worker has been taking, but which there are no available refills
(same drug, strength, and frequency).
DEFINITIONS
Dates to Know

6. Formulary
Features
Creation of 3 Distinct
Phases of Treatment
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Phase A:
Within first 30 days following injury or until
insurance carrier accepts claim; limited to a
30-day supply
Phase B:
After 30 days following the injury or after claim
is accepted; up to a 90-day supply
Perioperative:
4 days before or after surgery

7. Formulary Features
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Inclusion of
step therapies
Medications labeled
second line treatment
will require a trial of a
first line drug.
Injury specific
“YES”
on formulary for
many drugs
Ex: Warfarin is only on
formulary when injury
involves hip/groin or
knee.
DAW
requires prior
authorization
when generic
is available

8. Source: New York Workers’ Compensation Board
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New York State Drug Formulary
Access NYS Drug Formulary here.

9. IWP’s Internal Workflow
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If your Level 2 or Level 3 prior authorization request has been approved, please forward
the approval to nyformulary@IWPharmacy.com so that we may fill the prescription.
If the prescribed medication requires prior authorization an IWP Pharmacist will
contact the prescriber and recommend a drug on formulary when appropriate
IWP will fill new
prescription for
on formulary drug
Prescriber considers no on
formulary drugs appropriate
Prescriber agrees with
the Pharmacist
recommendation
Prescriber must follow
NY WCB process for prior
authorization

10. IWP is here to make
this transition painless.
We have an experienced team of workers’ compensation professionals
ready to make this transition as smooth as possible for your office.
Our robust team of clinical pharmacists are supported by
Claims and Prior Authorization Specialists with a comprehensive
understanding of drug formularies and New York specific nuances.
Not only are our clinical experts available to discuss alternative
treatment options with the prescriber, but we will also work with
providers on letters of medical necessity (LOMN) and prior authorization
requests.
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11. Contact Us
Injured Workers Pharmacy (IWP)
Toll-Free: 888-321-7945
Pharmacy Direct: 888-321-7945 ext.: 8337
Email: nyformulary@IWPharmacy.com
Website: www.IWPharmacy.com
Your designated IWP Territory Manager:
Nevenka Micev (Upstate NY)
Phone: 716-713-6584
nmicev@IWPharmacy.com
Rob White (New York City)
Phone: 347-515-2796
Email: rwhite@IWPharmacy.com
Brian Bliss (Bronx)
Phone: 888-321-7945 ext. 3285
Email: bbliss@IWPharmacy.com
New York Workers’ Compensation Board
Toll-Free: 877-632-4996
Email: Claims@wcb.ny.gov
Website: NY.gov