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.
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.
- A refill means any subsequent fill of a prescription when the number of refills is explicitly included in the original prescription.
- A renewal means a prescription that the injured worker has been taking but for which there are no available refills.
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:
- On or after December 5, 2019, during the 30 days following an injury, narcotics/opioids may not exceed a single seven-day supply; and,
- Prior to June 5, 2020, medical providers and injured workers must plan for a transition to a Drug Formulary medication. If such a transition is not medically appropriate, the medical provider must obtain prior authorization for a refill or renewal of a non-formulary narcotic/opioid well in advance of June 5, 2020.
Clarissa M. Rodriguez