S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1026
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 6, 2021
                                ___________
 
 Introduced  by  Sen.  RAMOS  -- read twice and ordered printed, and when
   printed to be committed to the Committee on Labor
 
 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:
 
   Section  1.  Paragraph 5 of subdivision (i) of section 13 of the work-
 ers' compensation law, as added by chapter 6 of the  laws  of  2007,  is
 amended and a new paragraph 6 is added to read as follows:
   (5) Notwithstanding any other provision of this chapter, if an employ-
 er or carrier has contracted with a pharmacy to provide prescribed medi-
 cine to claimants, then such employer or carrier may [require] ENCOURAGE
 claimants  to  obtain  all  prescribed  medicines from the pharmacy with
 which it has contracted[, except if a medical emergency  occurs  and  it
 would   not  be  reasonably  possible  to  obtain  immediately  required
 prescribed medicine from the pharmacy with which the employer or carrier
 has a contract]. An  employer  or  carrier  that  [requires]  ENCOURAGES
 claimants  to  obtain prescribed medicines from a pharmacy with which it
 has a contract must notify claimants of the pharmacy or pharmacies  with
 which  it has a contract, the locations and addresses of the pharmacy or
 pharmacies,  if  applicable,  how   to   initially   fill   and   refill
 prescriptions  through the mail, internet, telephone or other means, and
 any other required information that must be supplied to the pharmacy  or
 pharmacies.  [If  the  pharmacy or pharmacies with which the employer or
 carrier contracts does not offer mail order service and does not have  a
 physical  location  within  a  reasonable distance from the claimant, as
 defined by regulation of the board, the claimant may  obtain  prescribed
 medicines  at  the  pharmacy  or pharmacies of his or her choice and the
 employer or carrier will be liable for such charges in  accordance  with
 the fee schedule prescribed in section thirteen-o of this chapter] WHILE
 AN  EMPLOYER  OR  A  CARRIER  MAY  CONTRACT  WITH A NETWORK PHARMACY AND
 ENCOURAGE  CLAIMANTS  TO  USE  IT  EXCLUSIVELY,  CLAIMANTS  MAY   OBTAIN
              

 PRESCRIBED  MEDICINES  AT  THE PHARMACY OR PHARMACIES OF THEIR CHOICE SO
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04906-01-1

 S. 1026                             2
 
 LONG AS THAT PHARMACY IS REGISTERED AS  A  RESIDENT,  IN-STATE  PHARMACY
 WITH  THE  NEW  YORK STATE BOARD OF PHARMACY AND THE EMPLOYER OR CARRIER
 WILL BE LIABLE FOR SUCH CHARGES IN  ACCORDANCE  WITH  THE  FEE  SCHEDULE
 PRESCRIBED  IN SECTION THIRTEEN-O OF THIS ARTICLE SO LONG AS THE MEDICA-
 TIONS ARE CAUSALLY RELATED TO THE CLAIMANTS' WORK RELATED  INJURIES  AND
 ARE IN ACCORDANCE WITH THE NEW YORK STATE WORKERS' COMPENSATION PHARMACY
 FORMULARY AND ALL OTHER APPLICABLE BOARD REGULATIONS REGARDING PHARMACY.
 THIS  PARAGRAPH WILL NOT APPLY TO ANY RESIDENT, IN-STATE PHARMACIES THAT
 ARE CONTRACTED WITH THE NETWORK PHARMACY THAT THE  EMPLOYER  OR  CARRIER
 DESIGNATES  AS  THEIR  PREFERRED  AND  ENCOURAGED NETWORK PHARMACY. SUCH
 PHARMACIES ARE OBLIGATED TO PROCESS ALL CLAIMS  THROUGH  THEIR  CONTRACT
 WITH THE EMPLOYER'S OR CARRIER'S DESIGNATED NETWORK PHARMACY. THIS PARA-
 GRAPH  WILL  ALSO NOT APPLY TO ANY NON-RESIDENT, OUT-OF-STATE PHARMACIES
 NOR SHALL IT APPLY TO ANY COMPOUND  MEDICATIONS  THAT  THE  CLAIMANT  IS
 PRESCRIBED.  THE  EMPLOYER  OR  CARRIER  WILL HAVE THE RIGHT TO DENY ANY
 CHARGES THAT ORIGINATE FROM NON-RESIDENT,  OUT-OF-STATE  PHARMACIES  AND
 DENY  ANY  CHARGES  FOR NON-FDA APPROVED EXTEMPORANEOUS COMPOUND MEDICA-
 TIONS.
   (6) (I) ANY PHARMACIST LICENSED AND REGISTERED TO PRACTICE IN NEW YORK
 STATE PURSUANT TO ARTICLE ONE HUNDRED THIRTY-SEVEN OF THE EDUCATION  LAW
 SHALL  BE  PERMITTED TO DISPENSE MEDICATION TO A CLAIMANT OUTSIDE OF THE
 NETWORK WHERE:
   (A) THE CARRIER HAS REFUSED TO PAY FOR THE CLAIMANT'S  MEDICATION  AND
 THE CLAIMANT IS UNABLE TO ACCESS A NETWORK PHARMACY; OR
   (B) THE CLAIMANT'S MEDICATION NEEDS TO BE REAUTHORIZED MONTHLY, AND IS
 SO AUTHORIZED, BUT IS DENIED BECAUSE:
   (I) THE CARRIER FAILED TO RESPOND TO THE REAUTHORIZATION;
   (II)  MEDICAL  REPORTS  WERE  NOT FILED FOR REAUTHORIZATION OR A FILED
 MEDICAL REPORT CONTAINS A DEFECT;
   (III) THE MEDICATION HAS BEEN AUTHORIZED  IN  THE  PAST,  HOWEVER  THE
 CARRIER  DENIES AUTHORIZATION CLAIMING THAT THE MEDICAL TREATMENT GUIDE-
 LINES DO NOT SUPPORT REAUTHORIZATION;
   (IV) AN INDEPENDENT MEDICAL EXAMINER DISAGREES WITH REAUTHORIZATION;
   (V) REAUTHORIZATION HAS BEEN DENIED BECAUSE MAXIMUM  MEDICAL  IMPROVE-
 MENT HAS BEEN REACHED; OR
   (VI) THE CASE IS IN THE PROCESS OF BEING SETTLED.
   (II)  ANY  PHARMACY  THAT  AGREES TO DISPENSE MEDICATION TO A CLAIMANT
 UNDER SUBPARAGRAPH (I) OF THIS PARAGRAPH SHALL:
   (A) FOLLOW THE FEE SCHEDULE PRESCRIBED IN SECTION THIRTEEN-O  OF  THIS
 ARTICLE;
   (B) FOLLOW ALL TREATMENT GUIDELINES;
   (C)  FOLLOW  THE  NEW YORK STATE WORKERS' COMPENSATION PHARMACY FORMU-
 LARY;
   (D) VERIFY THAT THE MEDICATION IS CAUSALLY RELATED TO  THE  CLAIMANT'S
 WORK RELATED INJURIES; AND
   (E)  ASSUME  ALL  LIABILITY FOR THE MEDICATION IF A CASE IS NOT ESTAB-
 LISHED OR IF THE MEDICATION IS NOT LATER APPROVED.
   (III) UPON APPROVAL OF ANY MEDICATION DISPENSED BY A PHARMACY PURSUANT
 TO SUBPARAGRAPH (I) OF THIS PARAGRAPH, SUCH PHARMACY SHALL  BE  ENTITLED
 TO  RECEIVE  PROMPT  PAYMENT FOR SUCH MEDICATION FROM THE CARRIER WITHIN
 TEN DAYS OF SUCH APPROVAL, AND SHALL BE PERMITTED TO CONTINUE TO PROVIDE
 SUCH MEDICATION TO THE CLAIMANT AFTER  SUCH  CLAIMANT'S  CASE  HAS  BEEN
 ESTABLISHED OUTSIDE OF THE NETWORK.
   § 2. This act shall take effect immediately.