Senate Bill S4926

2025-2026 Legislative Session

Relates to contracted network pharmacy use

download bill text pdf

Sponsored By

Current Bill Status - On Floor Calendar


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2025-S4926 (ACTIVE) - Details

See Assembly Version of this Bill:
A6887
Law Section:
Workers' Compensation Law
Laws Affected:
Amd §13, Work Comp L
Versions Introduced in Other Legislative Sessions:
2019-2020: S7245, A8117
2021-2022: S1026, A1013
2023-2024: S1974, A1219

2025-S4926 (ACTIVE) - Summary

Relates to contracted network pharmacy use.

2025-S4926 (ACTIVE) - Sponsor Memo

2025-S4926 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4926
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 14, 2025
                                ___________
 
 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. Subdivision (i) of section 13 of the workers' compensation
 law is amended by adding a new paragraph 6 to read as follows:
   (6) (I) NOTWITHSTANDING PARAGRAPH FIVE OF THIS SUBDIVISION, A CLAIMANT
 SHALL NOT BE REQUIRED TO OBTAIN PRESCRIBED MEDICINES THROUGH A  PHARMACY
 WITH  WHICH  THE  EMPLOYER  OR  CARRIER  HAS  A  CONTRACT AND MAY OBTAIN
 PRESCRIBED MEDICINES FROM A PHARMACY OF SUCH CLAIMANT'S CHOICE WHEN:
   (A) THE EMPLOYER OR INSURANCE CARRIER HAS REFUSED TO  PROVIDE  PAYMENT
 FOR  THE  CLAIMANT'S PRESCRIBED MEDICATION AND THE CLAIMANT IS UNABLE TO
 OBTAIN THE PRESCRIBED MEDICATION FROM A PHARMACY WITH WHICH THE EMPLOYER
 OR CARRIER  HAS  A  CONTRACT  DUE  TO  THE  FAILURE  TO  AUTHORIZE  SUCH
 PRESCRIBED MEDICATION WITHIN SEVENTY-TWO HOURS OF SUCH REQUEST; OR
   (B) THE PRESCRIBED MEDICATION IS SCHEDULED FOR REAUTHORIZATION BUT THE
 EMPLOYER OR CARRIER HAS FAILED TO REAUTHORIZE SUCH PRESCRIBED MEDICATION
 WITHIN SEVENTY-TWO HOURS OF THE REQUEST FOR ONE OR MORE OF THE FOLLOWING
 REASONS:
   (I)  THE  EMPLOYER,  CARRIER, OR NETWORK PHARMACY FAILED TO RESPOND TO
 THE REAUTHORIZATION REQUEST;
   (II) MEDICAL REPORTS HAVE NOT YET BEEN FILED FOR REAUTHORIZATION, OR A
 FILED MEDICAL REPORT CONTAINS A DEFECT;
   (III) THE MEDICATION  HAS  BEEN  AUTHORIZED  PREVIOUSLY;  HOWEVER  THE
 EMPLOYER OR CARRIER DENIES REAUTHORIZATION ON THE BASIS THAT THE MEDICAL
 TREATMENT GUIDELINES 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09234-01-5
              

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