Bill S04926 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 pharmacies contracted by their employer or insurance carrier. This change is applicable when the employer or carrier fails to authorize payment for the medication within 72 hours or when reauthorization is not completed in a timely manner. The bill aims to enhance access to necessary medications for injured workers and streamline the process by which they can obtain their prescriptions without unnecessary delays.
Impact
The bill modifies existing workers' compensation regulations by providing greater flexibility for claimants in selecting pharmacies for their prescribed medications. It establishes conditions under which claimants can bypass contracted network pharmacies, thereby potentially improving access to medications and reducing delays in treatment. This change could lead to increased costs for employers and insurance carriers if claimants frequently utilize non-contracted pharmacies, but it also aims to ensure that injured workers receive timely care.
Sentiment
The sentiment around Bill S04926 appears to be largely positive, as evidenced by the unanimous support in the Senate Labor Committee and the strong majority in both the Senate and Assembly floor votes. The bill addresses a significant concern regarding access to medications for injured workers, which has garnered support from various stakeholders in the labor and healthcare sectors.
Contention
While the bill has received broad support, there may be concerns from employers and insurance carriers regarding the potential increase in costs associated with allowing claimants to choose their pharmacies. Some stakeholders may argue that the existing network pharmacy system is designed to control costs and ensure compliance with treatment guidelines, and that this bill could undermine those objectives by allowing claimants to bypass established protocols.
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.