S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1974
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 17, 2023
                                ___________
 
 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 to read as follows:
   (5)  (I)  Notwithstanding  any  other provision of this chapter, if an
 employer or carrier has contracted with a pharmacy to provide prescribed
 medicine 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]  WHEN
 AN  EMPLOYER  OR  INSURANCE CARRIER FAILS TO PROVIDE REQUIRED ACCESS FOR
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01454-01-3
              

 S. 1974                             2
 
 MEDICATION TO A CLAIMANT AS PER THE BOARD GUIDELINES AND PHARMACY FORMU-
 LARY, CLAIMANTS MAY THEN OBTAIN PRESCRIBED MEDICINES FROM ANY  RESIDENT,
 IN-STATE  PHARMACY LICENSED AND REGISTERED TO PRACTICE IN NEW YORK STATE
 PURSUANT  TO  ALL REQUIREMENTS OUTLINED IN SECTION 63.6 OF TITLE 8 NYCRR
 PART 63 UNDER THE FOLLOWING CIRCUMSTANCES:
   (A) THE NETWORK PHARMACY OR INSURANCE CARRIER HAS REFUSED TO  PAY  FOR
 THE  CLAIMANT'S  MEDICATION AND THE CLAIMANT IS UNABLE TO ACCESS MEDICA-
 TION THROUGH A NETWORK PHARMACY DUE TO THE FAILURE TO  AUTHORIZE  WITHIN
 SEVENTY-TWO HOURS OF SUCH REQUEST; OR
   (B)  THE  CLAIMANT'S  MEDICATION  NEEDS TO BE ON A SCHEDULE, AND IS SO
 AUTHORIZED, BUT HAS NOT BEEN AUTHORIZED WITHIN SEVENTY-TWO HOURS OF SUCH
 REQUEST BECAUSE:
   (I) THE INSURANCE CARRIER OR NETWORK PHARMACY FAILED TO RESPOND TO THE
 REAUTHORIZATION REQUEST;
   (II) MEDICAL REPORTS WERE NOT YET  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 PHARMACIST THAT AGREES TO DISPENSE MEDICATION TO  A  CLAIMANT
 UNDER THIS PARAGRAPH SHALL:
   (A) FOLLOW THE NEW YORK STATE WORKERS' COMPENSATION PHARMACY FEE SCHE-
 DULE PRESCRIBED IN SECTION THIRTEEN-O OF THIS ARTICLE;
   (B)  FOLLOW ALL NEW YORK STATE WORKERS' COMPENSATION MEDICAL TREATMENT
 GUIDELINES FOR THE CLAIMANT'S SITE OF INJURY FOR WHICH THE MEDICATION IS
 PRESCRIBED;
   (C) FOLLOW THE NEW YORK STATE WORKERS'  COMPENSATION  PHARMACY  FORMU-
 LARY; AND
   (D)  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 THIS PARAGRAPH, SUCH PHARMACY SHALL BE  ENTITLED  TO  RECEIVE  PROMPT
 PAYMENT  FOR  SUCH MEDICATION FROM THE INSURANCE CARRIER DIRECTLY WITHIN
 FORTY-FIVE BUSINESS DAYS OF SUCH APPROVAL, AND  SHALL  BE  PERMITTED  TO
 CONTINUE  TO  PROVIDE  SUCH  MEDICATION  TO  THE CLAIMANT OUTSIDE OF THE
 NETWORK AFTER SUCH CLAIMANT'S CASE HAS BEEN ESTABLISHED.
   § 2. This act shall take effect on the thirtieth day  after  it  shall
 have become a law. Effective immediately, the addition, amendment and/or
 repeal  of  any  rule  or regulation necessary for the implementation of
 this act on its effective date are authorized to be made  and  completed
 on or before such effective date.