Bill > A06887

This bill amends the workers' compensation law to provide more flexibility for claimants in obtaining prescribed medications when encountering difficulties with contracted network pharmacies. Specifically, a claimant can now obtain prescribed medicines from a pharmacy of their choice in two key scenarios: (1) when the employer or insurance carrier fails to authorize medication within 72 hours, or (2) when medication reauthorization is delayed or denied for various reasons, such as incomplete medical reports, disagreements about medical treatment guidelines, or ongoing case settlement. Any pharmacy choosing to dispense medication under these circumstances must adhere to 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. If the prescribed medication is later approved, the employer or carrier must reimburse the pharmacy within 45 business days at the established fee schedule rate, and the pharmacy can continue to dispense medication to the claimant. The bill aims to ensure workers can access necessary medications promptly and reduce potential delays in treatment caused by administrative complications with network pharmacies.

Labor and Employment

https://www.nysenate.gov/legislation/bills/2025/A6887