|SAME AS||No Same As|
|COSPNSR||Abbate, Benedetto, DenDekker, Brabenec|
|Amd 13, Work Comp L|
|Relates to contracted network pharmacy use.|
|06/03/2019||referred to labor|
|01/08/2020||referred to labor|
|05/28/2020||amend and recommit to labor|
|05/28/2020||print number 8117a|
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NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8117A SPONSOR: Bronson
TITLE OF BILL: An act to amend the workers' compensation law, in relation to contracted network pharmacy use   PURPOSE:: Authorizes workers' compensation claimants to use any in-state pharmacy that is. registered with the education department   SUMMARY OF PROVISIONS:: Sections one amends paragraph 5 of subdivision (i) of Section 13 of the workers'' compensation law, as added by chapter 6 of the laws of 2007, by ' allowing workers compensation claimants to obtain prescribed medi- cines at a pharmacy of their choice, so long as that pharmacy is regis- tered as a resident, in-state pharmacy with NYSED. Section two sets forth-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, in-state 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.   FISCAL IMPACT: To be determined   PRIOR LEGISLATIVE HISTORY:: A8356 of 2017-18: referred to Labor   EFFECTIVE DATE:: This act will take effect on the one hundred twentieth day after it shall have become a law.
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STATE OF NEW YORK ________________________________________________________________________ 8117--A 2019-2020 Regular Sessions IN ASSEMBLY June 3, 2019 ___________ Introduced by M. of A. BRONSON, ABBATE, BENEDETTO, DenDEKKER, BRABENEC -- Multi-Sponsored by -- M. of A. HEVESI -- 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 commit- tee 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 and a new paragraph 6 is added to read as follows: 4 (5) Notwithstanding any other provision of this chapter, if an employ- 5 er or carrier has contracted with a pharmacy to provide prescribed medi- 6 cine to claimants, then such employer or carrier may [ require] encourage 7 claimants to obtain all prescribed medicines from the pharmacy with 8 which it has contracted[ , except if a medical emergency occurs and it9 would not be reasonably possible to obtain immediately required10 prescribed medicine from the pharmacy with which the employer or carrier11 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 or19 carrier contracts does not offer mail order service and does not have a20 physical location within a reasonable distance from the claimant, as21 defined by regulation of the board, the claimant may obtain prescribedEXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD13089-02-0A. 8117--A 2 1 medicines at the pharmacy or pharmacies of his or her choice and the2 employer or carrier will be liable for such charges in accordance with3 the fee schedule prescribed in section thirteen-o of this chapter] While 4 an employer or a carrier may contract with a network pharmacy and 5 encourage claimants to use it exclusively, claimants may obtain 6 prescribed medicines at the pharmacy or pharmacies of their choice so 7 long as that pharmacy is registered as a resident, in-state pharmacy 8 with the New York state board of pharmacy and the employer or carrier 9 will be liable for such charges in accordance with the fee schedule 10 prescribed in section thirteen-o of this article so long as the medica- 11 tions are causally related to the claimants' work related injuries and 12 are in accordance with the New York state workers' compensation pharmacy 13 formulary and all other applicable board regulations regarding pharmacy. 14 This paragraph will not apply to any resident, in-state pharmacies that 15 are contracted with the network pharmacy that the employer or carrier 16 designates as their preferred and encouraged network pharmacy. Such 17 pharmacies are obligated to process all claims through their contract 18 with the employer's or carrier's designated network pharmacy. This para- 19 graph will also not apply to any non-resident, out-of-state pharmacies 20 nor shall it apply to any compound medications that the claimant is 21 prescribed. The employer or carrier will have the right to deny any 22 charges that originate from non-resident, out-of-state pharmacies and 23 deny any charges for non-FDA approved extemporaneous compound medica- 24 tions. 25 (6) (i) Any pharmacist licensed and registered to practice in New York 26 state pursuant to article one hundred thirty-seven of the education law 27 shall be permitted to dispense medication to a claimant outside of the 28 network where: 29 (A) the carrier has refused to pay for the claimant's medication and 30 the claimant is unable to access a network pharmacy; or 31 (B) the claimant's medication needs to be reauthorized monthly, and is 32 so authorized, but is denied because: 33 (I) the carrier failed to respond to the reauthorization; 34 (II) medical reports were not filed for reauthorization or a filed 35 medical report contains a defect; 36 (III) the medication has been authorized in the past, however the 37 carrier denies authorization claiming that the medical treatment guide- 38 lines do not support reauthorization; 39 (IV) an independent medical examiner disagrees with reauthorization; 40 (V) reauthorization has been denied because maximum medical improve- 41 ment has been reached; or 42 (VI) the case is in the process of being settled. 43 (ii) Any pharmacy that agrees to dispense medication to a claimant 44 under subparagraph (i) of this paragraph shall: 45 (A) follow the fee schedule prescribed in section thirteen-o of this 46 article; 47 (B) follow all treatment guidelines; 48 (C) follow the New York state workers' compensation pharmacy formu- 49 lary; 50 (D) verify that the medication is causally related to the claimant's 51 work related injuries; and 52 (E) assume all liability for the medication if a case is not estab- 53 lished or if the medication is not later approved. 54 (iii) Upon approval of any medication dispensed by a pharmacy pursuant 55 to subparagraph (i) of this paragraph, such pharmacy shall be entitled 56 to receive prompt payment for such medication from the carrier withinA. 8117--A 3 1 ten days of such approval, and shall be permitted to continue to provide 2 such medication to the claimant after such claimant's case has been 3 established outside of the network. 4 § 2. This act shall take effect immediately.