WORKERS COMPENSATION FORMULARY FAILING INJURED WORKERS

It is becoming increasing difficult to work within the NYS WCB system.

The NYS WCB pharmacy formulary implementation is bad.  From across the spectrum of the workers’ compensation world – patients, prescribers, attorneys, pharmacies – the same news is heard repeatedly: 

Patients have no access to medications, even medications that are formulary approved.  Even patients with established cases on the same medications for years are losing access to their medicines.  Even patient with medical portal authorizations are not being allowed access to their medications!  Attorneys are swamped by their clients and overwhelmed scheduling WCB hearings with no guarantee of any success.

But there is no better source of confirmation for the chaos and misery being visited upon the injured workers than the NYS Workers’ Compensation Board itself.  Below are statements from actual NYS WCB nurses attempting to solve the issues being heaped upon them by desperate patients.  The comments have been transcribed to the best of our memories:

 

Pharmacy:           “We have called the adjuster; she is not calling us back”

 

WCB:                     “I can’t get her (the adjuster) to call back either.”

 

 

WCB:                     “Caremark (largest Pharmacy benefit manager in the US) won’t even talk to us.”

 

 

WCB:                     “Oh, I know it’s bad, we spend every day calling insurance companies and calling third parties and checking with the pharmacies to see if it went through and calling back.”

 

 

WCB:                     “It’s a huge mess, it’s been a mess for a while.”

 

Pharmacy:           ” I’m sure you are spending most of your day calling insurance companies trying to get

                              drugs authorized.”

 

WCB:                     “It’s bad, and I’m sorry, it is frustrating, all the pharmacies we talk to, they all have the same thing happening.            

 

 

WCB:                     ”Oh, I know absolutely, I agree, and we fight with them (unnamed large insurance carrier) more than we fight with anyone else. We say yes, we are going to approve the medication and they say no!

 

WCB:                     “Yes, this is a broken system.  We are trying to fix it.”

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