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A08117 Summary:

A08117 Actions:

A08117 Memo:

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.
 
 
 
 
 
 
 
 
 
 
 
 
 
 

A08117 Text:

 
                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  it
     9  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
    19  carrier contracts does not offer mail order service and does not have  a
    20  physical  location  within  a  reasonable distance from the claimant, as
    21  defined by regulation of the board, the claimant may  obtain  prescribed

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD13089-02-0
        A. 8117--A                          2

     1  medicines  at  the  pharmacy  or pharmacies of his or her choice and the
     2  employer or carrier will be liable for such charges in  accordance  with
     3  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 within
        A. 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.