Bill > S04926

This bill modifies the workers' compensation law to provide more flexibility for workers seeking prescribed medications when they encounter difficulties with their employer's or insurance carrier's contracted pharmacy network. Specifically, a worker can now obtain prescribed medicines from a pharmacy of their choice in two key scenarios: (1) when the employer or carrier fails to authorize medication within 72 hours of a request, or (2) when medication reauthorization is delayed or denied for various reasons, such as unresponded requests, medical report issues, treatment guideline disputes, or ongoing case settlement. Any pharmacy choosing to serve the worker must adhere to specific requirements, including following the New York state workers' compensation pharmacy fee schedule, medical treatment guidelines, and pharmacy formulary. Additionally, the pharmacy assumes liability for medication charges if the case is not established. Once a prescribed medication is approved, the employer or carrier must reimburse the pharmacy within 45 business days at the prescribed fee schedule rate, and the pharmacy can continue to dispense medication to the worker. The bill aims to ensure workers can access necessary medications promptly and without undue bureaucratic obstacles.

Labor and Employment

https://www.nysenate.gov/legislation/bills/2025/S4926