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

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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--C

                               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  -- again reported from said committee with amend-
          ments, ordered reprinted as amended and recommitted to said  committee
          --  recommitted  to the Committee on Labor in accordance with Assembly
          Rule  3,  sec.  2  --  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 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
    19  carrier contracts does not offer mail order service and does not have  a

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04906-10-2
        A. 1013--C                          2

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