New York State Workers’ Compensation Board Announces Launch Dates for OnBoard Limited Release
February 4, 2022
The New York Workers’ Compensation Board is implementing an online system called OnBoard, which will replace the paper-based claims systems and eCase system with a single, web-based platform. The Board announced on Thursday, February 3, 2022, the Onboard Limited Release will be implemented in three phases, with Phase One beginning March 7, 2022. Phase One will include medication prior authorization requests and Form HP-1.0. Phase Two will include durable medical equipment prior authorization requests and it will begin on April 4, 2022. Phase Three will launch on May 2, 2022 and will include testing and treatment prior authorization requests. Phase One: March 7, 2022 Medication Prior Authorization Request (PAR) and Form HP-1.0 The OnBoard medication PAR process will replace the current prior authorization request process. Medical marijuana will also be requested through the OnBoard medication PAR, replacing the current use of Form MG-2. The drug formulary application within the Medical Portal will be off-line as of 5:00 pm EST on Friday, March 4, 2022. It will be available as a “read only” file on March 7, 2022. All prior authorization requests that are in progress at 5:00 pm on March 4, 2022, will be suspended and converted to a Medication PAR in the new OnBoard Limited Release platform. At 7:00 am EST on Monday, March 7, 2022, Medication PARs will be submitted and processed using the OnBoard Limited Release platform. All refill and renewal prescriptions will be subject to the New York Drug Formulary as of March 7, 2022. Beginning March 7, 2022, health care providers will submit Form HP-1.0 on-line to request Board action on unpaid medical bills. Payers will continue to process those forms as they do today. Phase Two: April 4, 2022 Durable Medical Equipment (DME) Prior Authorization Request (PAR) Beginning on April 4, 2022, DME PARs will be submitted using the OnBoard Limited Release platform. Requests should be made in accordance with the new DME fee schedule and guidelines published on January 19, 2022. The Board’s DME Fee Schedule Page can be found HERE. Phase Three: May 2, 2022 Treatment/Testing Prior Authorization Request (PAR) The OnBoard Limited Release platform will begin accepting Medical Treatment Guideline (MTG) and non-MTG PARs on May 2, 2022. Health care providers will be required to submit the information necessary to process the PAR. Over the last several months the Board has adopted over a dozen new treatment guidelines. They will all become effective on May 2, 2022. Board training on the new treatment guidelines can be found HERE. Payer Information The current HP-1, C-4AUTH, MG-1 and MG-2 forms will become obsolete as each Phase of the OnBoard Limited Release platform is implemented. The HP-1 form will end on March 7, 2022 The MG-2 form for medical marijuana requests only will end on March 7, 2022 All other forms will end on May 2, 2022 For more detailed information and tips on how you can best prepare for the OnBoard Limited Release implementation, please visit the Board’s OnBoard Limited Release Update Page. The Mitchell Pharmacy Solutions team has been closely following the development of the OnBoard Limited Release Platform and we are ready to process Medication PARs upon the launch of Phase One on March 7, 2022. If you have questions about this information, please contact Brian Allen, Vice President of Government Affairs for Mitchell Pharmacy Solutions, at Brian.Allen@mitchell.com or at 1-801-903-5754.
Dave Torrence: Top Three Workers’ Compensation Trends to Know in 2022
January 19, 2022
Opioid Addiction Drug Buprenorphine Increases Risk of Dental Issues According to FDA
January 19, 2022
The Food and Drug Administration (FDA) recently issued a warning concerning the risk of dental problems resulting from medications used to treat opioid addiction and pain. The warning concerns oral buprenorphine medications that are placed against the inside of the cheek or dissolved under the tongue. The use of this treatment has been reported to cause tooth decay, infection, and even tooth loss in patients – even those with no history of dental issues. The FDA originally approved buprenorphine treatment for opioid use disorder (OUD) as tablets in 2002 and then as a film in 2015. The warning applies to buprenorphine products as a single ingredient (used to treat pain) and in combination with naloxone under the brand names Belbuca®, Bunavail®, Cassipa®, Suboxone®, Subutex®, and Zubsolv® or as their generic equivalents. Currently, other forms of buprenorphine have not been identified by the FDA as increasing risk of dental health concerns. The FDA warning was a result of dental adverse events reported through the FDA Adverse Event Reporting System (FAERS) database and the medical literature. The FDA recommends that one should not suddenly stop taking buprenorphine medication without talking to your health care professional due to risk of withdrawal symptoms and relapse to opioid use or misuse for those taking it for OUD. Moreover, one should take their buprenorphine medication and swish a large sip of water around their mouth after the medication is completely dissolved and then wait one hour prior to brushing your teeth. It is also important to maintain regular dental visits and inform the dentist when taking or when starting these medications. One should notify their healthcare provider and seek dental evaluation if they experience problems, and can contact the FDA MedWatch Program to track safety issues concerning this medication or any other medications. Even though some of these problems have been significant, it is important to note that the benefits to taking buprenorphine clearly outweigh the risks and the medication remains a very important tool to treating OUD. In regard to the workers’ compensation industry, there may be an increased expense to clients associated with potential additional dental costs, especially in those taking Belbuca® products for pain. Buprenorphine products represent a small number of active prescriptions for our injured workers, but they remain a meaningful intervention in the recovery process for many. Mitchell Pharmacy Solutions will continue to monitor and provide any relevant updates to ongoing issues regarding buprenorphine dental risks and the effects they may have on the treatment of injured workers. For more information, please read the FDA Drug Safety Communication .
Is the Supply Chain Creating Critical Drug Shortages?
December 29, 2021
With the country well into the holiday season, issues with supply chains have made their way into pharmacies across the nation. Recently, the Food and Drug Administration (FDA) showed that there are about 111 drugs on backorder. These include medications for heart conditions, antibiotics, and cancer drugs. Currently, there are no medications on the list that represent a large volume of active prescriptions for workers’ compensation. Regardless, delayed access to maintenance drugs for additional chronic conditions can have an impact on injured worker treatment and recovery. An important point to note is that about 80 percent of active pharmaceutical ingredient manufacturers are located outside of the U.S. According to the FDA, manufacturing and quality problems, delays and discontinuations can cause drug shortages. The backlog of cargo ships that have been sitting offshore outside of ports may be a reason for some of the current supply issues and drug shortages. Adding to the possible supply chain disruptions in local pharmacies is the staffing issues that many pharmacies are experiencing. According to the National Community Pharmacists Association (NCPA), a survey last month found that 60% of respondents were dealing with supply chain disruptions and 70% were struggling to fill staff positions. For more information, visit the FDA drug shortages site.
Washington State Formulary Update
December 3, 2021
Washington state has announced updates to its drug formulary, effective January 1, 2022. The following is a list of updated drugs and therapeutic classes (or class codes) and their status on the Washington State Department of Labor and Industries outpatient formulary. Authorization Requirements: beclomethasone dipropionate (Qvar RediHaler), budesonide suspension for nebulization (Pulmicort), fluticasone propionate (Flovent Diskus/HFA), and budesonide/formoterol fumarate (Symbicort) now require authorization with coverage based on acceptance of pulmonary condition antiretrovirals now require prior authorization except for the following agents: darunavir, darunavir/cobicistat, dolutegravir, elvitegravir/ cobicistat/ emtricitabine/ tenofovir disoproxil, emtricitabine, emtricitabine/tenofovir disoproxil, emtricitabine/rilpivirine/tenofovir disoproxil, lamivudine, raltegravir, rilpivirine, ritonavir, tenofovir disoproxil, zidovudine Mitchell Pharmacy Solutions will work with our clients to identify impacted claimants and assist with formulary change notifications as needed. For more information, please see the updated preferred drug list for additional information and exceptions.
Could Virtual Reality Be the Next Treatment for Chronic Pain?
November 23, 2021
Is virtual reality (VR) the latest tool to help fight chronic pain? A recent FDA approval suggests VR treatment may be part of the expanding use of technology for medical treatments. On November 16, 2021, the U.S. Food and Drug Administration (FDA) authorized a prescription-only treatment of chronic back pain utilizing a virtual reality system. EaseVRx aims to use a VR headset and the principles of cognitive behavioral treatment (CBT) to help reduce pain and pain interference through breathing exercises and improved awareness of internal signals. . The EaseVRx program consists of 56 VR sessions that are 2-16 minutes long as part of an eight-week treatment program. The FDA authorized EaseVRx based on an eight-week study of 179 people with chronic, low back pain that had lasted six months or longer. Half of the participants used the EaseVRx program and the other half participated in a two-dimensional virtual reality program that did not use CBT methods. According to the FDA “At the end of treatment, 66% of EaseVRx participants reported a greater than 30% reduction in pain, compared to 41% of control participants who reported a greater than 30% reduction in pain.” The reduction in pain remained for up to three months after the study for people in the EaseVRx group but not for the control group. Over the last decade, digital therapeutics have become more commonplace, undergoing review and being cleared or approved by the FDA. The EaseVRx system could possibly be used as an alternative to medications, such as opioids, for chronic back pain. Research has shown that CBT may reduce the burden of chronic pain and increase function through an emotional, cognitive and behavioral approach to shift negative beliefs held by patients about the relationship between their pain and movement. As we continue to learn more about the possibilities of virtual reality and the benefits of CBT, the industry may see more interest in alternative treatment methods like EaseVRx.
Release of Generic Medications for Workers' Comp in 2022
November 16, 2021
Next year twenty-eight drugs relevant to workers’ compensation are expected to become available as generics. These formulations will be made available once the original drug manufacturer’s brand name period of exclusivity has expired. According to the FDA, 9 out of 10 prescriptions filled in the United States are for generic drugs. Brand drugs with equivalent generic formulations are an essential category to monitor, as these drugs are by far the most expensive. Prescriber education surrounding the use of generics is increasingly key when prescribers or patients request brand drugs as more generics become available. The following table provides information on drugs expected to be approved as generic equivalents in 2022. At the time of this publication generic pricing was not available. Download the Full Chart