Bill Text: NY A01013 | 2021-2022 | General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relates to contracted network pharmacy use.

Spectrum: Moderate Partisan Bill (Democrat 4-1)

Status: (Introduced - Dead) 2022-04-22 - print number 1013c [A01013 Detail]

Download: New_York-2021-A01013-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         1013--A

                               2021-2022 Regular Sessions

                   IN ASSEMBLY

                                     January 7, 2021
                                       ___________

        Introduced  by  M. of A. BRONSON, ABBATE, BENEDETTO, BRABENEC, HEVESI --
          read once  and  referred  to  the  Committee  on  Labor  --  committee
          discharged, bill amended, ordered reprinted as amended and recommitted
          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.
                                                                   LBD04906-04-1
        A. 1013--A                          2

     1  prescribed medicines at the pharmacy or pharmacies of  their  choice  so
     2  long  as  such  pharmacy  is registered as a resident, in-state pharmacy
     3  with the New York state board of pharmacy and the  employer  or  carrier
     4  shall  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 shall 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 shall be  obligated  to  process  all  claims  through  their
    13  contract  with  the employer's or carrier's designated network pharmacy.
    14  This paragraph shall not apply to any non-resident, out-of-state pharma-
    15  cies nor shall it apply to any compound medications that the claimant is
    16  prescribed. The employer or carrier shall 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 requires monthly reauthorization, 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  reauthorization  claiming  that  the  medical  treatment
    33  guidelines 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.