S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1013
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 7, 2021
                                ___________
 
 Introduced  by  M. of A. BRONSON, ABBATE, BENEDETTO, BRABENEC, HEVESI --
   read once and referred to the Committee on Labor
 
 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 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD04906-02-1

 A. 1013                             2
 
 ENCOURAGE  CLAIMANTS  TO  USE  IT  EXCLUSIVELY,  CLAIMANTS  MAY   OBTAIN
 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.
   § 2. This act shall take effect immediately.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1013--A
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              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:
 
   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.
                                                            LBD04906-04-1

 A. 1013--A                          2

 PRESCRIBED MEDICINES AT THE PHARMACY OR PHARMACIES OF  THEIR  CHOICE  SO
 LONG  AS  SUCH  PHARMACY  IS REGISTERED AS A RESIDENT, IN-STATE PHARMACY
 WITH THE NEW YORK STATE BOARD OF PHARMACY AND THE  EMPLOYER  OR  CARRIER
 SHALL  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 SHALL 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 SHALL BE  OBLIGATED  TO  PROCESS  ALL  CLAIMS  THROUGH  THEIR
 CONTRACT  WITH  THE EMPLOYER'S OR CARRIER'S DESIGNATED NETWORK PHARMACY.
 THIS PARAGRAPH SHALL NOT APPLY TO ANY NON-RESIDENT, OUT-OF-STATE PHARMA-
 CIES NOR SHALL IT APPLY TO ANY COMPOUND MEDICATIONS THAT THE CLAIMANT IS
 PRESCRIBED. THE EMPLOYER OR CARRIER SHALL 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 REQUIRES MONTHLY REAUTHORIZATION, 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  REAUTHORIZATION  CLAIMING  THAT  THE  MEDICAL  TREATMENT
 GUIDELINES 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.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1013--B
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              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

 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
              

 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04906-05-1

 A. 1013--B                          2

 ENCOURAGE  CLAIMANTS  TO  USE  IT  EXCLUSIVELY,  CLAIMANTS  MAY   OBTAIN
 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.