STATE OF NEW YORK
________________________________________________________________________
1026--A
Cal. No. 555
2021-2022 Regular Sessions
IN SENATE(Prefiled)
January 6, 2021
___________
Introduced by Sen. RAMOS -- read twice and ordered printed, and when
printed to be committed to the Committee on Labor -- recommitted to
the Committee on Labor in accordance with Senate Rule 6, sec. 8 --
reported favorably from said committee, ordered to first and second
report, ordered to a third reading, passed by Senate and delivered to
the Assembly, recalled, vote reconsidered, restored to third reading,
amended and ordered reprinted, retaining its place in the order of
third reading
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. Paragraph 5 of subdivision (i) of section 13 of the work-
2 ers' compensation law, as added by chapter 6 of the laws of 2007, is
3 amended to read as follows:
4 (5) (i) Notwithstanding any other provision of this chapter, if an
5 employer or carrier has contracted with a pharmacy to provide prescribed
6 medicine to claimants, then such employer or carrier may [require]
7 encourage claimants to obtain all prescribed medicines from the pharmacy
8 with which it has contracted[, except if a medical emergency occurs and
9 it would not be reasonably possible to obtain immediately required
10 prescribed medicine from the pharmacy with which the employer or carrier
11 has a contract]. An employer or carrier that [requires] encourages
12 claimants to obtain prescribed medicines from a pharmacy with which it
13 has a contract must notify claimants of the pharmacy or pharmacies with
14 which it has a contract, the locations and addresses of the pharmacy or
15 pharmacies, if applicable, how to initially fill and refill
16 prescriptions through the mail, internet, telephone or other means, and
17 any other required information that must be supplied to the pharmacy or
18 pharmacies. [If the pharmacy or pharmacies with which the employer or
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04906-09-2
S. 1026--A 2
1 carrier contracts does not offer mail order service and does not have a
2 physical location within a reasonable distance from the claimant, as
3 defined by regulation of the board, the claimant may obtain prescribed
4 medicines at the pharmacy or pharmacies of his or her choice and the
5 employer or carrier will be liable for such charges in accordance with
6 the fee schedule prescribed in section thirteen-o of this chapter] When
7 an employer or insurance carrier fails to provide required access for
8 medication to a claimant as per the board guidelines and pharmacy formu-
9 lary, claimants may then obtain prescribed medicines from any resident,
10 in-state pharmacy licensed and registered to practice in New York state
11 pursuant to all requirements outlined in section 63.6 of title 8 NYCRR
12 part 63 under the following circumstances:
13 (A) the network pharmacy or insurance carrier has refused to pay for
14 the claimant's medication and the claimant is unable to access medica-
15 tion through a network pharmacy due to the failure to authorize within
16 seventy-two hours of such request; or
17 (B) the claimant's medication needs to be on a schedule, and is so
18 authorized, but has not been authorized within seventy-two hours of such
19 request because:
20 (I) the insurance carrier or network pharmacy failed to respond to the
21 reauthorization request;
22 (II) medical reports were not yet filed for reauthorization, or a
23 filed medical report contains a defect;
24 (III) the medication has been authorized in the past; however the
25 carrier denies authorization claiming that the medical treatment guide-
26 lines do not support reauthorization;
27 (IV) an independent medical examiner disagrees with reauthorization;
28 (V) reauthorization has been denied because maximum medical improve-
29 ment has been reached; or
30 (VI) the case is in the process of being settled.
31 (ii) Any pharmacist that agrees to dispense medication to a claimant
32 under this paragraph shall:
33 (A) follow the New York state workers' compensation pharmacy fee sche-
34 dule prescribed in section thirteen-o of this article;
35 (B) follow all New York state workers' compensation medical treatment
36 guidelines for the claimant's site of injury for which the medication is
37 prescribed;
38 (C) follow the New York state workers' compensation pharmacy formu-
39 lary; and
40 (D) assume all liability for the medication if a case is not estab-
41 lished or if the medication is not later approved.
42 (iii) Upon approval of any medication dispensed by a pharmacy pursuant
43 to this paragraph, such pharmacy shall be entitled to receive prompt
44 payment for such medication from the insurance carrier directly within
45 forty-five business days of such approval, and shall be permitted to
46 continue to provide such medication to the claimant outside of the
47 network after such claimant's case has been established.
48 § 2. This act shall take effect on the thirtieth day after it shall
49 have become a law. Effective immediately, the addition, amendment and/or
50 repeal of any rule or regulation necessary for the implementation of
51 this act on its effective date are authorized to be made and completed
52 on or before such effective date.