Senate Bill S7245A

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7245--A
 
                             I N  S E N A T E
 
                             January 14, 2020
                                ___________
 
 Introduced  by  Sens. RAMOS, GIANARIS -- read twice and ordered printed,
   and when printed to be committed to the Committee on Labor --  commit-
   tee  discharged, bill amended, ordered reprinted as amended and recom-
   mitted 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:
 
   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 a new paragraph 6 is 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] ENCOURAGE
 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]  ENCOURAGES
 claimants  to  obtain prescribed medicines 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, internet, telephone or other means, and
 any other required information that must be supplied to the pharmacy  or
 pharmacies.  [If  the  pharmacy or pharmacies with which the employer or
 carrier contracts does not offer mail order service and does not have  a
 physical  location  within  a  reasonable 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 thirteen-o of this chapter] WHILE
 AN  EMPLOYER  OR  A  CARRIER  MAY  CONTRACT  WITH A NETWORK PHARMACY AND
 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.
                                                            LBD13089-03-0

 S. 7245--A                          2

 PRESCRIBED  MEDICINES  AT  THE PHARMACY OR PHARMACIES OF THEIR CHOICE SO
 LONG AS THAT PHARMACY IS REGISTERED AS  A  RESIDENT,  IN-STATE  PHARMACY
 WITH  THE  NEW  YORK STATE BOARD OF PHARMACY AND THE EMPLOYER OR CARRIER
 WILL  BE  LIABLE  FOR  SUCH  CHARGES IN ACCORDANCE WITH THE FEE SCHEDULE
 PRESCRIBED IN SECTION THIRTEEN-O OF THIS ARTICLE SO LONG AS THE  MEDICA-
 TIONS  ARE  CAUSALLY RELATED TO THE CLAIMANTS' WORK RELATED INJURIES AND
 ARE IN ACCORDANCE WITH THE NEW YORK STATE WORKERS' COMPENSATION PHARMACY
 FORMULARY AND ALL OTHER APPLICABLE BOARD REGULATIONS REGARDING PHARMACY.
 THIS PARAGRAPH WILL NOT APPLY TO ANY RESIDENT, IN-STATE PHARMACIES  THAT
 ARE  CONTRACTED  WITH  THE NETWORK PHARMACY THAT THE EMPLOYER OR CARRIER
 DESIGNATES AS THEIR PREFERRED  AND  ENCOURAGED  NETWORK  PHARMACY.  SUCH
 PHARMACIES  ARE  OBLIGATED  TO PROCESS ALL CLAIMS THROUGH THEIR CONTRACT
 WITH THE EMPLOYER'S OR CARRIER'S DESIGNATED NETWORK PHARMACY. THIS PARA-
 GRAPH WILL ALSO NOT APPLY TO ANY NON-RESIDENT,  OUT-OF-STATE  PHARMACIES
 NOR  SHALL  IT  APPLY  TO  ANY COMPOUND MEDICATIONS THAT THE CLAIMANT IS
 PRESCRIBED. THE EMPLOYER OR CARRIER WILL HAVE  THE  RIGHT  TO  DENY  ANY
 CHARGES  THAT  ORIGINATE  FROM NON-RESIDENT, OUT-OF-STATE PHARMACIES AND
 DENY ANY CHARGES FOR NON-FDA APPROVED  EXTEMPORANEOUS  COMPOUND  MEDICA-
 TIONS.
   (6) (I) ANY PHARMACIST LICENSED AND REGISTERED TO PRACTICE IN NEW YORK
 STATE  PURSUANT TO ARTICLE ONE HUNDRED THIRTY-SEVEN OF THE EDUCATION LAW
 SHALL BE PERMITTED TO DISPENSE MEDICATION TO A CLAIMANT OUTSIDE  OF  THE
 NETWORK WHERE:
   (A)  THE  CARRIER HAS REFUSED TO PAY FOR THE CLAIMANT'S MEDICATION AND
 THE CLAIMANT IS UNABLE TO ACCESS A NETWORK PHARMACY; OR
   (B) THE CLAIMANT'S MEDICATION NEEDS TO BE REAUTHORIZED MONTHLY, AND IS
 SO AUTHORIZED, BUT IS DENIED BECAUSE:
   (I) THE CARRIER FAILED TO RESPOND TO THE REAUTHORIZATION;
   (II) MEDICAL REPORTS WERE NOT FILED FOR  REAUTHORIZATION  OR  A  FILED
 MEDICAL REPORT CONTAINS A DEFECT;
   (III)  THE  MEDICATION  HAS  BEEN  AUTHORIZED IN THE PAST, HOWEVER THE
 CARRIER DENIES AUTHORIZATION CLAIMING THAT THE MEDICAL TREATMENT  GUIDE-
 LINES 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
   (VI) THE CASE IS IN THE PROCESS OF BEING SETTLED.
   (II) ANY PHARMACY THAT AGREES TO DISPENSE  MEDICATION  TO  A  CLAIMANT
 UNDER SUBPARAGRAPH (I) OF THIS PARAGRAPH SHALL:
   (A)  FOLLOW  THE FEE SCHEDULE PRESCRIBED IN SECTION THIRTEEN-O OF THIS
 ARTICLE;
   (B) FOLLOW ALL TREATMENT GUIDELINES;
   (C) FOLLOW THE NEW YORK STATE WORKERS'  COMPENSATION  PHARMACY  FORMU-
 LARY;
   (D)  VERIFY  THAT THE MEDICATION IS CAUSALLY RELATED TO THE CLAIMANT'S
 WORK RELATED INJURIES; AND
   (E) ASSUME ALL LIABILITY FOR THE MEDICATION IF A CASE  IS  NOT  ESTAB-
 LISHED OR IF THE MEDICATION IS NOT LATER APPROVED.
   (III) UPON APPROVAL OF ANY MEDICATION DISPENSED BY A PHARMACY PURSUANT
 TO  SUBPARAGRAPH  (I) OF THIS PARAGRAPH, SUCH PHARMACY SHALL BE ENTITLED
 TO RECEIVE PROMPT PAYMENT FOR SUCH MEDICATION FROM  THE  CARRIER  WITHIN
 TEN DAYS OF SUCH APPROVAL, AND SHALL BE PERMITTED TO CONTINUE TO PROVIDE
 SUCH  MEDICATION  TO  THE  CLAIMANT  AFTER SUCH CLAIMANT'S CASE HAS BEEN
 ESTABLISHED OUTSIDE OF THE NETWORK.
   § 2. This act shall take effect immediately.