On Jun. 11, 2025, NY DoL adopted amendments regarding network pharmacies.
Provided path for claimants to obtain medically necessary medication either through use of network pharmacy or by notice of ability to use an out-of-network pharmacy.
Adoption published in Jun. 11, 2025 State Register; changes effective Jul. 11, 2025.
On Dec. 11, NY DoL proposed amendments re network pharmacies.
Provides that a payer must notify claimant that they may use a non-network pharmacy when the payer objects that medication is for board-unaccepted treatment or injury.
Applies if the self-insured employer or carrier has filed/will file a legal objection to prescription medication contending that it treats non-established body site/condition.
Also, if self-insured employer/insurance carrier has not accepted liability for condition.
Failure to dispense and pay for such prescribed medications prior to providing notice subjects the self-insured employer or insurance carrier, to at least $2k in penalties.
The requirement to use a designated independent pharmacy, chain pharmacy, or pharmacy benefit manager, not be effective until all notification requirements are met.
Also, addresses service process by self-insured employer, insurance carrier, or agent.
Comment Period
Notice of proposed rule making will be published in the Dec. 31, 2024 issue of the NY Register and comments on the proposal will be accepted for 60 days after publication.
Jun. 2025 NY DoL Rule Adoption
On Jun. 11, 2025, NY DoL adopted amendments regarding network pharmacies.
Provided path for claimants to obtain medically necessary medication either through use of network pharmacy or by notice of ability to use an out-of-network pharmacy.
Adoption published in Jun. 11, 2025 State Register; changes effective Jul. 11, 2025.
Regulators
NY DoL
Entity Types
CNSM; IB; Ins
Reference
NY SR Vol. XLVII Is. 23 p. 13, PR, RF, 6/11/2025; PR, RF, 12/11/2024; Citation: *NY LEG* 12-V-M-440-440.3, 12-V-M-440-440.4, 12-V-M-440-440.4;
