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Subject Number 046-1198 Planning for Drug Formulary Implementation

Board Bulletins and Subject Numbers

August 13, 2019

The Chair adopted a Drug Formulary on June 5, 2019. This Subject Number outlines important information regarding the implementation of the Drug Formulary and the transition of prescriptions to Drug Formulary medications.

New Prescriptions

As of December 5, 2019, any newly prescribed drug must be for a Drug Formulary medication. As of that date, a medical provider must obtain prior authorization for any non-formulary drug prior to writing a new prescription. A new prescription means a prescription for a drug that the patient is not currently taking (different drug or different strength or frequency).

Note: A newly-written prescription for continuation/renewal of a medication (same drug, strength and frequency) that the patient is taking is considered a renewal prescription and must follow the process described below.

Refills and Renewals

Insurers, self-insured employers and third-party administrators must notify medical providers and injured workers by December 5, 2019, that a currently prescribed drug is not included on the Drug Formulary. These notifications must be in the format required by the Chair. Please see Injured Worker Formulary Notification and Provider Formulary Notification for the required format. On or after June 5, 2020, all refills or renewals of prescriptions must use a Drug Formulary medication unless prior authorization has been obtained before the date of the refill or renewal.

Narcotics/Opioids

The Drug Formulary does not include narcotics/opioids after the first 30 days following an injury (except in the immediate pre- and post-operative period). It is important to understand that:

Clarissa M. Rodriguez
Chair