WCB Issues Drug Formulary, CMS-1500 Template
The New York State Workers’ Compensation Board (WCB) recently implemented a prescription drug formulary, which lists the medications eligible for reimbursement under workers' comp medical coverage. As of December 5, 2019, all new prescriptions for workers’ comp claimants were to comply with the requirements of the formulary.
Beginning June 5, 2020, all refills and renewals must comply with the formulary. We urge medical providers to discuss medications with NYSIF claimants to determine if their medication is reimbursable under workers’ comp medical coverage and make appropriate changes as necessary. Providers must either switch the patient to a formulary drug or request a prior authorization from the WCB for approval to continue a non-formulary drug.
For more information, visit the New York Workers’ Compensation Drug Formulary website.
WCB Develops Template for Submitting Form CMS-1500
The WCB also has developed a template that providers can use to complete the medical narrative report when submitting Form CMS-1500 to the Board to request payment for treating injured workers.
The template contains three mandatory elements to include with most narratives: the patient’s work status, causal relationship of the injury to the patient's work activities, and temporary impairment percentage. The WCB noted that a medical narrative report may be found legally defective if these elements are missing.
A provider may be able to submit their own medical narrative report if it includes work status, causal relationship and temporary impairment percentage, the WCB said.
The CMS-1500 requirements and template are available on the WCB website.