New York Senate Bill S9331 was introduced, which would align workers’ comp regulations with existing Workers’ Compensation Board regulations governing access to prescription medication, including objective, time-based standards for out of network pharmacy use.

The bill would allow injured workers to obtain prescribed medication from an out-of-network pharmacy without prior Board approval when specified conditions occur, including:

• Dispensing delays by a contracted network pharmacy
• Failure to issue timely authorization or reauthorization decisions
• Emergency medical circumstances
• Other situations authorized by the Board

Out of network pharmacies would be required to comply with the workers’ comp pharmacy fee schedule, medical treatment guidelines, and formulary, and would assume financial responsibility if a claim or medication is later determined to be non-compensable. The bill also clarifies that out of network dispensing may not be used as evidence of compensability or medical necessity.

The bill also requires the Board to submit a report within three years analyzing out of network pharmacy utilization, medication access delays, costs, and administrative impacts. If enacted, the bill would take effect 60 days after becoming law and would allow the Board to adopt or update any necessary rules before that date.