New York Codes, Rules and Regulations
Title 12 - DEPARTMENT OF LABOR
Chapter V - Workers' Compensation
Subchapter M - Pharmacy And Durable Medical Goods Fee Schedules And Appendices
Part 441 - Formulary
Section 441.3 - Applicability, Effective Dates and Notice

Universal Citation: 12 NY Comp Codes Rules and Regs ยง 441.3

Current through Register Vol. 45, No. 52, December 27, 2023

The Formulary shall apply to all prescriptions following an accident or injury regardless of the date of accident or disablement and regardless of where the claimant lives. The Formulary shall be subject to the following:

(a) Effective Dates.

(1) New Prescriptions. Six months from the effective date of this Part, every new prescription shall be prescribed and dispensed consistent with the Formulary and this Part regardless of the date of accident or disablement and subject to any required Prior Authorization.

(2) Refill and Renewal Prescriptions. On or after September 13, 2021, every refill and renewal prescription shall be prescribed and dispensed consistent with the Formulary and this Part regardless of the date of accident or disablement and subject to any required Prior Authorization.

(b) The Formulary shall apply to prescriptions for accidents or injuries that are controverted by the insurance carrier or self-insured employer.

(c) The Pharmacy Fee Schedule set forth in Part 440 of this Subchapter remains in effect and includes pricing for prescriptions including Compound Drugs, the rules governing use of pharmacy networks and payments for prescriptions when the claim is controverted.

(d) The Formulary shall not apply to drugs when such drugs are administered in a hospital or medical provider's office.

(e) The Formulary shall apply to drugs that are dispensed by a medical provider acting within the scope of his or her practice and pursuant to the dispensing limitations set forth in section 6807(2) of the Education Law.

(f) Notice. The insurance carrier or self-insured employer shall identify all claimants with current prescriptions for Non-Formulary drugs and provide written notification to the claimant and to the prescribing medical provider. Notice to the prescribing medical provider and to the claimant shall be in the format prescribed by the Chair.

Adopted New York State Register June 5, 2019/Volume XLI, Issue 22, eff. 6/5/2019

Amended New York State Register September 1, 2021/Volume XLIII, Issue 35, eff. 9/1/2021

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