New York State Workers' Compensation Board Provides Updates on Prior Authorization Requests
Brian Allen
VP of Government Affairs, Enlyte Pharmacy Solutions
Late Tuesday evening, March 31, 2020, the New York State Workers' Compensation Board released new guidance on how to handle prior authorization requests.
Non-Pharmacy Prior Authorization Requests
Non-pharmacy prior authorization requests should be sent to the carrier or administrator's designated email found on the Board's website. Since many individuals are now working remotely, faxes may not be receiving timely follow-up. The Board also noted that fax documents should be forwarded to the insurance carrier's designated email contact to ensure that requests are being processed.
Pharmacy-Related Prior Authorization Requests
Pharmacy-related prior authorization requests for non-formulary medications should still be submitted using the medical portal. Any requests that are not handled in the appropriate time frame are subject to review and an Order of the Chair to mitigate the delay. Administrators using the portal should ensure that the proper emails are entered into the system to prevent any routing delays.
The Board also noted that the drug formulary rules and authorization process have not changed. Carriers and employers should be adhering to the formulary guidelines and not implementing stricter formulary requirements or changing the prior authorization requirements related to formulary medications. The Board is monitoring authorization requests in the portal and deviations from the rules could result in administrative fines.
Mitchell Pharmacy Solutions is continually monitoring changes coming from the states' workers' compensation and auto insurance regulators. We will keep you advised of changes impacting the provision of pharmacy care in these areas. To review our 50-state guide with links to all of the COVID-19 changes in the various states, please click here.
For questions regarding this alert or how Mitchell Pharmacy Solutions is responding to the evolving changes in the states, please contact your client services manager.