S T A T E O F N E W Y O R K
________________________________________________________________________
6992--A
2009-2010 Regular Sessions
I N A S S E M B L Y
March 18, 2009
___________
Introduced by M. of A. GIANARIS, HEVESI, ABBATE, BENEDETTO, ZEBROWSKI --
Multi-Sponsored by -- M. of A. CHRISTENSEN, HEASTIE -- read once and
referred to the Committee on Labor -- 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
prescription prices and pharmacies for injured employees and to repeal
section 88 of such law relating thereto
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 and three new paragraphs 6, 7 and 8 are added to read as
follows:
(5) Notwithstanding any other provision of this chapter, if an employ-
er or carrier has contracted with a pharmacy to provide prescribed medi-
cine to claimants, then such employer or carrier may require 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 claimants to obtain prescribed medi-
cines 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, inter-
net, telephone or other means, and any other required information that
must be supplied to the pharmacy or pharmacies. If the pharmacy or phar-
macies with which the employer or carrier contracts does not offer mail
order service and does not have a physical location within a reasonable
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10198-03-0
A. 6992--A 2
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 thir-
teen-o of this chapter. PROVIDED, HOWEVER, THAT AN EMPLOYER OR CARRIER
SHALL BE PROHIBITED FROM REFUSING TO ALLOW A CLAIMANT TO UTILIZE A PHAR-
MACY OF HIS OR HER CHOICE TO FURNISH THE PRESCRIBED MEDICATIONS REQUIRED
BY THE CLAIMANT AS LONG AS SUCH PHARMACY'S CHARGES COMPLY WITH THE
PUBLISHED PRICES AS DEFINED IN PARAGRAPH SIX OF THIS SUBDIVISION.
(6) IF AN EMPLOYER OR CARRIER HAS CONTRACTED WITH A PHARMACY PURSUANT
TO PARAGRAPH FIVE OF THIS SUBDIVISION THEN SUCH EMPLOYER OR CARRIER
SHALL BE REQUIRED TO SUBMIT AND PUBLISH THE PRICES FOR ALL AVAILABLE
MEDICINES, INCLUDING ALL MANAGEMENT FEES THAT ARE PAID FOR PHARMACY
SERVICES, TO THE BOARD. THE BOARD SHALL ESTABLISH RULES AND REGULATIONS
TO PROVIDE FOR THE DISSEMINATION AND ACCESS OF THE PRICES SUBMITTED AND
PUBLISHED BY THE EMPLOYER OR CARRIER TO ANY PHARMACY WHO HAS NOT
CONTRACTED WITH AN EMPLOYER OR CARRIER.
(7) ANY PHARMACY THAT HAS PROVIDED PRESCRIBED MEDICINE TO A CLAIMANT
AND HAS NOT BEEN REIMBURSED IN ACCORDANCE WITH THE PROVISIONS OF PARA-
GRAPH ONE OF THIS SUBDIVISION SHALL BE ENTITLED TO MAINTAIN AN ACTION
AGAINST THE EMPLOYER AND CARRIER TO RECOVER THE AMOUNTS DUE TO SUCH
PHARMACY PURSUANT TO THIS SUBDIVISION IN ACCORDANCE WITH REGULATIONS TO
BE ESTABLISHED BY THE BOARD OR THE CHAIRMAN. WHERE A PHARMACY BILL HAS
BEEN DETERMINED TO BE DUE AND OWING IN ACCORDANCE WITH THE PROVISIONS OF
THIS SUBDIVISION, THE BOARD SHALL INCLUDE IN THE AMOUNT OF THE AWARD
INTEREST OF NOT MORE THAN ONE AND ONE-HALF PERCENT PER MONTH PAYABLE TO
THE PHARMACY IN ACCORDANCE WITH THE RULES AND REGULATIONS PROMULGATED BY
THE BOARD.
(8) NOTWITHSTANDING ANY OTHER PROVISION IN THIS CHAPTER, THE INITIAL
FILL OF A PRESCRIPTION MEDICINE IN CONNECTION WITH A CLAIM FOR BENEFITS
UNDER THIS CHAPTER SHALL NOT CONTAIN A SUPPLY OF SUCH MEDICINE FOR A
PERIOD OF LONGER THAN FOURTEEN DAYS. FOR THE PURPOSES OF THIS PARAGRAPH,
"INITIAL FILL" SHALL BE DEFINED AS A PRESCRIPTION OR A COMBINATION OF
PRESCRIPTIONS FOR MEDICATION ISSUED BY AN AUTHORIZED MEDICAL PROVIDER AT
THE TIME OF DISCOVERY OF INJURY OR ILLNESS BUT SHALL NOT INCLUDE
PRESCRIPTIONS THAT MAY BE WRITTEN SEVENTY-TWO HOURS OR MORE FROM THE
TIME OF INITIAL MEDICAL CARE.
S 2. Section 88 of the workers' compensation law, as amended by chap-
ter 635 of the laws of 1996, is amended to read as follows:
S 88. Administration expenses. The entire expense of administering the
state insurance fund shall be paid out of such fund which shall not be
considered an agency or a fund of the state for the purposes of section
four of the state finance law. The portion of such expenses applicable
and chargeable to the disability benefits fund shall be determined on an
equitable basis with due allowance for the division of overhead
expenses. There shall be submitted to the director of the budget quar-
terly financial statements on a calendar year basis. In no case shall
the amount of administrative expenditures so authorized for an entire
year from the workers' compensation fund exceed twenty-five per centum
of the earned premiums for such insurance for that year. [In no case
shall the amount of administrative expenditures authorized for the disa-
bility benefits fund for an entire year exceed twenty-five per centum of
the premiums earned by that fund for such insurance for that year.] No
payment, expenditure or refund out of the state insurance fund shall be
subject to pre-audit by the department of audit and control as provided
by section one hundred eleven of the state finance law. All appointments
A. 6992--A 3
to positions in the state insurance fund shall be made subject to civil
service requirements.
S 3. Section 88 of the workers' compensation law, as amended by chap-
ter 6 of the laws of 2007, is REPEALED.
S 4. This act shall take effect immediately.