STATE OF NEW YORK
________________________________________________________________________
7245--A
IN SENATE
January 14, 2020
___________
Introduced by Sens. RAMOS, GIANARIS -- read twice and ordered printed,
and when printed to be committed to the Committee on Labor -- commit-
tee discharged, bill amended, ordered reprinted as amended and recom-
mitted 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. 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
22 medicines at the pharmacy or pharmacies of his or her choice and the
23 employer or carrier will be liable for such charges in accordance with
24 the fee schedule prescribed in section thirteen-o of this chapter] While
25 an employer or a carrier may contract with a network pharmacy and
26 encourage claimants to use it exclusively, claimants may obtain
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13089-03-0
S. 7245--A 2
1 prescribed medicines at the pharmacy or pharmacies of their choice so
2 long as that pharmacy is registered as a resident, in-state pharmacy
3 with the New York state board of pharmacy and the employer or carrier
4 will be liable for such charges in accordance with the fee schedule
5 prescribed in section thirteen-o of this article so long as the medica-
6 tions are causally related to the claimants' work related injuries and
7 are in accordance with the New York state workers' compensation pharmacy
8 formulary and all other applicable board regulations regarding pharmacy.
9 This paragraph will not apply to any resident, in-state pharmacies that
10 are contracted with the network pharmacy that the employer or carrier
11 designates as their preferred and encouraged network pharmacy. Such
12 pharmacies are obligated to process all claims through their contract
13 with the employer's or carrier's designated network pharmacy. This para-
14 graph will also not apply to any non-resident, out-of-state pharmacies
15 nor shall it apply to any compound medications that the claimant is
16 prescribed. The employer or carrier will have the right to deny any
17 charges that originate from non-resident, out-of-state pharmacies and
18 deny any charges for non-FDA approved extemporaneous compound medica-
19 tions.
20 (6) (i) Any pharmacist licensed and registered to practice in New York
21 state pursuant to article one hundred thirty-seven of the education law
22 shall be permitted to dispense medication to a claimant outside of the
23 network where:
24 (A) the carrier has refused to pay for the claimant's medication and
25 the claimant is unable to access a network pharmacy; or
26 (B) the claimant's medication needs to be reauthorized monthly, and is
27 so authorized, but is denied because:
28 (I) the carrier failed to respond to the reauthorization;
29 (II) medical reports were not filed for reauthorization or a filed
30 medical report contains a defect;
31 (III) the medication has been authorized in the past, however the
32 carrier denies authorization claiming that the medical treatment guide-
33 lines do not support reauthorization;
34 (IV) an independent medical examiner disagrees with reauthorization;
35 (V) reauthorization has been denied because maximum medical improve-
36 ment has been reached; or
37 (VI) the case is in the process of being settled.
38 (ii) Any pharmacy that agrees to dispense medication to a claimant
39 under subparagraph (i) of this paragraph shall:
40 (A) follow the fee schedule prescribed in section thirteen-o of this
41 article;
42 (B) follow all treatment guidelines;
43 (C) follow the New York state workers' compensation pharmacy formu-
44 lary;
45 (D) verify that the medication is causally related to the claimant's
46 work related injuries; and
47 (E) assume all liability for the medication if a case is not estab-
48 lished or if the medication is not later approved.
49 (iii) Upon approval of any medication dispensed by a pharmacy pursuant
50 to subparagraph (i) of this paragraph, such pharmacy shall be entitled
51 to receive prompt payment for such medication from the carrier within
52 ten days of such approval, and shall be permitted to continue to provide
53 such medication to the claimant after such claimant's case has been
54 established outside of the network.
55 § 2. This act shall take effect immediately.
