NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1219A
SPONSOR: Bronson TITLE OF BILL:
An act to amend the workers' compensation law, in relation to contracted
network pharmacy use
PURPOSE OR GENERAL IDEA OF BILL:
To authorize workers' compensation claimants to use any in-state pharma-
cy that is registered with the education department.
SUMMARY OF PROVISIONS:
Sections 1-2 of the bill amend paragraph 5 of subdivision (i) of section
13 of the workers' compensation law, as added by chapter 6 of the laws
of 2007.
Section 1 of the bill allows employers or insurance carriers to encour-
age claimants to obtain all prescribed medications from contracted phar-
macies.
Provides requirement for the employer to notify claimants of the pharma-
cy or pharmacies with which it has contracted, the respective locations
and addresses, and if applicable, on how to fill and refill
prescriptions through the mail, internet, telephone or other means and
any other information that needs to be provided to the pharmacy.
Provides circumstances under which a claimant can obtain prescribed
medications from out-of-network pharmacies if an employer or carrier
fails to provide the required access for medication to the claimant.
Provides requirements for dispensation of medication by pharmacists and
establishes liability for medication.
Requires the insurance carrier to pay the pharmacy directly within
forty-five business days of approval of any dispensed medication.
Section 2 sets the effective date.
DIFFERENCE BETWEEN ORIGINAL AND AMENDED VERSION (IF APPLICABLE):
Makes technical changes and does not require the pharmacy to verify that
the medication is causally related to the claimant's work-related inju-
ries.
Increases the number of days within which the insurance carrier must pay
the pharmacy upon approval of any dispensed medication from 10 to 45
days.
Changes the effective date.
JUSTIFICATION:
This bill will provide workers compensation claimants with greater flex-
ibility by allowing them to fill their prescriptions not only at network
pharmacies with whom an employer or carrier encourages an exclusive
relationship, but also at pharmacies that are registered as resident,
instate pharmacies with the New York State Department of Education.
While providing injured claimants with the convenience they need to
best. remedy their ailments, this legislation also has the added benefit
of conferring economic gain to our State's small businesses.
LEGISLATIVE HISTORY:
A1013Cof 2021-22:referredto Labor;
A1250of 2019-20:referredto Labor;
A8356of 2017-18:referredto Labor
FISCALIMPLICATIONS:
To be determined.
EFFECTIVE DATE:
This act shall take effect on the thirtieth day after it shall become
law.
STATE OF NEW YORK
________________________________________________________________________
1219--A
2023-2024 Regular Sessions
IN ASSEMBLY
January 13, 2023
___________
Introduced by M. of A. BRONSON, BENEDETTO, BRABENEC, HEVESI, COLTON,
DeSTEFANO, DURSO -- read once and referred to the Committee on Labor
-- recommitted to the Committee on Labor in accordance with Assembly
Rule 3, sec. 2 -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee
AN ACT to amend the workers' compensation law, in relation to contracted
network pharmacy use
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision (i) of section 13 of the workers' compensation
2 law is amended by adding a new paragraph 6 to read as follows:
3 (6) (i) Notwithstanding paragraph five of this subdivision, a claimant
4 shall not be required to obtain prescribed medicines through a pharmacy
5 with which the employer or carrier has a contract and may obtain
6 prescribed medicines from a pharmacy of his or her choice when:
7 (A) the employer or insurance carrier has refused to provide payment
8 for the claimant's prescribed medication and the claimant is unable to
9 obtain the prescribed medication from a pharmacy with which the employer
10 or carrier has a contract due to the failure to authorize such
11 prescribed medication within seventy-two hours of such request; or
12 (B) the prescribed medication is scheduled for reauthorization but the
13 employer or carrier has failed to reauthorize such prescribed medication
14 within seventy-two hours of the request for one or more of the following
15 reasons:
16 (I) the employer, carrier, or network pharmacy failed to respond to
17 the reauthorization request;
18 (II) medical reports have not yet been filed for reauthorization, or a
19 filed medical report contains a defect;
20 (III) the medication has been authorized previously; however the
21 employer or carrier denies reauthorization on the basis that the medical
22 treatment guidelines do not support reauthorization;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01454-02-4
A. 1219--A 2
1 (IV) an independent medical examiner disagrees with reauthorization;
2 (V) reauthorization has been denied because maximum medical improve-
3 ment has been reached; or
4 (VI) the case is in the process of being settled.
5 (ii) Any pharmacy that agrees to dispense prescribed medication to a
6 claimant pursuant to subparagraph (i) of this paragraph shall:
7 (A) adhere to the amounts prescribed by the fee schedule adopted under
8 the New York state workers' compensation pharmacy fee schedule
9 prescribed in section thirteen-o of this article;
10 (B) adhere to the New York state workers' compensation medical treat-
11 ment guidelines authorized under subdivision five of section thirteen-a
12 of this article for the claimant's site of injury for which the medica-
13 tion is prescribed;
14 (C) follow the New York state workers' compensation pharmacy formulary
15 prescribed under section thirteen-p of this article; and
16 (D) assume all liability for charges for such prescribed medication in
17 accordance with the fee schedule prescribed under section thirteen-o of
18 this article if a case is not established or if the prescribed medica-
19 tion is not later approved.
20 (iii) Upon approval of any prescribed medication dispensed by a phar-
21 macy pursuant to this subparagraph, such pharmacy shall be entitled to
22 submit a claim to the employer or its carrier for payment of such
23 prescribed medication or for reimbursement of the cost of such
24 prescribed medication. The employer or carrier shall pay the amount
25 prescribed by the fee schedule prescribed under section thirteen-o of
26 this article, or if the prescribed medication is not included on the
27 current fee schedule, the usual and customary charges for such
28 prescribed medication within forty-five business days of such approval.
29 Such pharmacy shall be permitted to continue to dispense such prescribed
30 medication to the claimant outside of the network after payment or
31 reimbursement of payment for the prescribed medication is established.
32 § 2. This act shall take effect on the thirtieth day after it shall
33 have become a law. Effective immediately, the addition, amendment and/or
34 repeal of any rule or regulation necessary for the implementation of
35 this act on its effective date are authorized to be made and completed
36 on or before such effective date.
