Bill A06887 amends the workers' compensation law in New York to allow claimants to obtain prescribed medications from pharmacies of their choice, rather than being restricted to those with which their employer or insurance carrier has a contract. This change is applicable under specific conditions, such as when the employer or carrier fails to authorize payment for the medication within a specified timeframe, or when reauthorization is delayed or denied for various reasons. The bill also outlines the responsibilities of pharmacies that dispense medications under these circumstances, including adherence to fee schedules and liability for charges if a case is not established or the medication is not approved.
Impact
The bill impacts the current workers' compensation framework by increasing the options available to claimants regarding where they can obtain their prescribed medications. It modifies existing statutes to provide greater flexibility and access to necessary medications, potentially improving health outcomes for injured workers. The bill also places additional responsibilities on pharmacies to comply with state guidelines and fee schedules, which may affect their operational practices and financial arrangements with employers and insurance carriers.
Sentiment
The sentiment around Bill A06887 appears to be largely positive, as indicated by the favorable votes in the Assembly Labor and Rules Committees, with a significant majority of members supporting the bill. The discussions suggest a recognition of the need for greater access to medications for claimants and a desire to streamline the process for obtaining necessary treatments.
Contention
While the bill has garnered support, there may be contention regarding the financial implications for employers and insurance carriers, who might be concerned about increased costs associated with allowing claimants to choose their pharmacies. Additionally, there may be concerns from some stakeholders about the potential for abuse of the system or the impact on the existing network of contracted pharmacies.
Codifies certain regulations of the workers' compensation board relating to access to prescription medication and coordination with workers' compensation board regulations governing network pharmacy use; requires the workers' compensation board to file a report on out-of-network pharmacy use within 3 years of the effective date.
Codifies certain regulations of the workers' compensation board relating to access to prescription medication and coordination with workers' compensation board regulations governing network pharmacy use; requires the workers' compensation board to file a report on out-of-network pharmacy use within 3 years of the effective date.
Prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.
prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.