Bill Text: NY S01026 | 2021-2022 | General Assembly | Amended

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Bill Title: Relates to contracted network pharmacy use.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed - Dead) 2022-05-23 - referred to labor [S01026 Detail]

Download: New_York-2021-S01026-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         1026--A
            Cal. No. 555

                               2021-2022 Regular Sessions

                    IN SENATE

                                       (Prefiled)

                                     January 6, 2021
                                       ___________

        Introduced  by  Sen.  RAMOS  -- read twice and ordered printed, and when
          printed to be committed to the Committee on Labor  --  recommitted  to
          the  Committee  on  Labor  in accordance with Senate Rule 6, sec. 8 --
          reported favorably from said committee, ordered to  first  and  second
          report,  ordered to a third reading, passed by Senate and delivered to
          the Assembly, recalled, vote reconsidered, restored to third  reading,
          amended  and  ordered  reprinted,  retaining its place in the order of
          third reading

        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 to read as follows:
     4    (5)  (i)  Notwithstanding  any  other provision of this chapter, if an
     5  employer or carrier has contracted with a pharmacy to provide prescribed
     6  medicine to claimants, then  such  employer  or  carrier  may  [require]
     7  encourage claimants to obtain all prescribed medicines from the pharmacy
     8  with  which it has contracted[, except if a medical emergency occurs and
     9  it 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

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04906-09-2
        S. 1026--A                          2

     1  carrier  contracts does not offer mail order service and does not have a
     2  physical location within a reasonable distance  from  the  claimant,  as
     3  defined  by  regulation of the board, the claimant may obtain prescribed
     4  medicines  at  the  pharmacy  or pharmacies of his or her choice and the
     5  employer or carrier will be liable for such charges in  accordance  with
     6  the  fee schedule prescribed in section thirteen-o of this chapter] When
     7  an employer or insurance carrier fails to provide  required  access  for
     8  medication to a claimant as per the board guidelines and pharmacy formu-
     9  lary,  claimants may then obtain prescribed medicines from any resident,
    10  in-state pharmacy licensed and registered to practice in New York  state
    11  pursuant  to  all requirements outlined in section 63.6 of title 8 NYCRR
    12  part 63 under the following circumstances:
    13    (A) the network pharmacy or insurance carrier has refused to  pay  for
    14  the  claimant's  medication and the claimant is unable to access medica-
    15  tion through a network pharmacy due to the failure to  authorize  within
    16  seventy-two hours of such request; or
    17    (B)  the  claimant's  medication  needs to be on a schedule, and is so
    18  authorized, but has not been authorized within seventy-two hours of such
    19  request because:
    20    (I) the insurance carrier or network pharmacy failed to respond to the
    21  reauthorization request;
    22    (II) medical reports were not yet  filed  for  reauthorization,  or  a
    23  filed medical report contains a defect;
    24    (III)  the  medication  has  been  authorized in the past; however the
    25  carrier denies authorization claiming that the medical treatment  guide-
    26  lines do not support reauthorization;
    27    (IV) an independent medical examiner disagrees with reauthorization;
    28    (V)  reauthorization  has been denied because maximum medical improve-
    29  ment has been reached; or
    30    (VI) the case is in the process of being settled.
    31    (ii) Any pharmacist that agrees to dispense medication to  a  claimant
    32  under this paragraph shall:
    33    (A) follow the New York state workers' compensation pharmacy fee sche-
    34  dule prescribed in section thirteen-o of this article;
    35    (B)  follow all New York state workers' compensation medical treatment
    36  guidelines for the claimant's site of injury for which the medication is
    37  prescribed;
    38    (C) follow the New York state workers'  compensation  pharmacy  formu-
    39  lary; and
    40    (D)  assume  all  liability for the medication if a case is not estab-
    41  lished or if the medication is not later approved.
    42    (iii) Upon approval of any medication dispensed by a pharmacy pursuant
    43  to this paragraph, such pharmacy shall be  entitled  to  receive  prompt
    44  payment  for  such medication from the insurance carrier directly within
    45  forty-five business days of such approval, and  shall  be  permitted  to
    46  continue  to  provide  such  medication  to  the claimant outside of the
    47  network after such claimant's case has been established.
    48    § 2. This act shall take effect on the thirtieth day  after  it  shall
    49  have become a law. Effective immediately, the addition, amendment and/or
    50  repeal  of  any  rule  or regulation necessary for the implementation of
    51  this act on its effective date are authorized to be made  and  completed
    52  on or before such effective date.