Medical & Pharmacy Benefits

April 2021 - Changes to Your Pharmacy Benefits: With the New York State Workers’ Compensation Board’s Prescription Drug Formulary slated to take effect on June 7, 2021, now’s the time to talk with your medical provider to determine if your prescription medications are covered under this new plan. If they do not qualify, your doctor will have to get authorization for you to continue your current medication or you will have to be prescribed a new medication. To learn more, visit the WCB Formulary website.

Medical Network Benefits

NYSIF offers a medical provider network for workers’ compensation claimants.

Locate a medical network provider in New York State.

Locate a medical network provider in all other states (select Coventry Integrated Network in the Networks drop-down menu).

Request a local provider listing at 1-800-842-2917.

Medical benefits cover hospitalization, doctor services, dentistry, physical therapy, chiropractic, x-rays, laboratory tests, nursing services, and durable medical goods.

Claimants have the right to choose any medical provider authorized by the Workers’ Compensation Board to provide medical care for work-related injuries or illnesses.

Pharmacy Network Benefits

Claimants pay no out-of-pocket expenses for prescription medication for work-related injuries or illnesses when they use NYSIF's prescription benefits program through the CareComp Network of CVS Caremark.

If a claimant is prescribed medication for a work-related injury or illness, it must be filled at a pharmacy within the CareComp pharmacy network.

Use the CVS Caremark Pharmacy Locator or call CVS Caremark at 1-866-493-1640 to find a local network pharmacy. Claimants who have not received a CVS Caremark card should contact their NYSIF case manager.

Exceptions to the mandate for claimants to fill prescriptions in-network are listed below. Claimants must obtain medication from a network pharmacy unless they qualify under one of the following exceptions:

  • The claimant is refilling an existing prescription – they must switch to an in-network pharmacy within 60 days for a non-controlled substance and 90 days for a controlled substance.
  • The claimant lives in either (a) a rural area, and there is not a network pharmacy within 15 miles or (b) a non-rural area, and there is not a network pharmacy within five miles, and one of these two circumstances applies:
    • the claimant is unable to order by mail or telephone in the network, and no pharmacy in the network will deliver to the claimant; or
    • the claimant has a medical emergency, and it is not reasonably possible for a network remote pharmacy to deliver medications needed for that emergency within the time prescribed by the doctor

Diagnostic Testing Network Benefits

Effective June 1, 2021, if a treating physician prescribes a diagnostic procedure, it must be performed through one of the NYSIF-contracted Diagnostic Testing Networks.

A diagnostic testing network (DTN) schedules MRIs, CAT scans, radiology and other diagnosis tests with New York State Workers’ Compensation Board-authorized providers who have agreed to provide these services.

For your convenience, tests can be scheduled at facilities within a reasonable distance of your home or workplace. To schedule a CT, MRI, EMG/NCS, Diagnostic Ultrasound or X-Ray, please contact a NYSIF-contracted Diagnostic Testing Network.

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