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Board Announces Draft Pharmacy Formulary and Finalizes SLU Guidelines

On 12/28/17, the Board announced draft regulations for a proposed New York State Pharmacy Formulary and finalized the new Permanent Impairment Guidelines for Schedule Loss of Use (SLU) evaluations.  

WCL §13-p, which became law in April 2017, required the Board to "establish a comprehensive prescription drug formulary on or before" 12/31/17. The Board has apparently interpreted the "shall establish" language in WCL §13-p to only mean "publish proposed regulations for comment." The proposed formulary provides a list of preferred and non-preferred medications for treatment of common workers' compensation injuries. Medications on the preferred list do not require pre-authorization from the carrier but those on the non-preferred list do. Of note, not a single opioid medication is on the preferred list. We will review the formulary as well as the proposed regulations in detail and publish a detailed analysis of same in the coming weeks. The public comment period for the proposed regulations is open until 2/26/18.  

The Board also finalized and adopted the new Permanent Impairment Guidelines for SLU evaluations. They appear to be substantially unchanged with only minor clarifications to the Proposed Guidelines the Board issued on 11/22/17 for public comment that we discussed in last month's issue. The primary consideration in determining SLU under these new guidelines is loss of range of motion. The new guidelines take effect for all claims, regardless of date of injury, on 1/1/18. The only exception to this is if the claimant had at least one SLU exam conducted under prior Guidelines before 1/1/18. In such cases, the Board will determine the claimant's SLU using the 2012 Guidelines.

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