BILL NUMBER: S9331
SPONSOR: RAMOS
 
TITLE OF BILL:
An act to amend the workers' compensation law, in relation to access to
prescription medication and coordination with workers' compensation
board regulations governing network pharmacy use
 
PURPOSE:
To ensure timely access to medically necessary prescription medication
for injured workers by codifying existing Workers' Compensation Board
regulations governing out-of-network pharmacy access, while preserving
the Board's regulatory authority and addressing the concerns raised in
the Governor's 2025 veto message.
 
SUMMARY OF PROVISIONS:
Section one sets forth detailed legislative findings and intent, clari-
fying that the bill codifies and harmonizes existing regulatory
protections adopted by the Workers' Compensation Board in July 2025,
establishes objective and time-based standards to minimize disputes, and
preserves full regulatory flexibility.
Section two amends subdivision (i) of section 13 of the workers' compen-
sation law by adding a new paragraph six. This paragraph permits an
injured worker to obtain prescribed medication from a pharmacy of the
claimant's choice outside a contracted network only when clearly
defined, objective conditions occur, including documented dispensing
delays, failure to issue timely authorization decisions, emergency
medical circumstances, or other conditions expressly authorized by Board
regulation. The bill expressly provides that these conditions are self-
executing and do not require a prior Board determination.
The bill requires pharmacies dispensing medication under these circum-
stances to comply with the workers' compensation fee schedule, medical
treatment guidelines, and formulary, and to assume financial risk if a
claim or medication is later determined to be non-compensable. Payment
obligations and timelines are tied directly to existing Board regu-
lations. The bill further clarifies that out-of-network dispensing shall
not be used as evidence of compensability or medical necessity.
Section three requires the Workers' Compensation Board to submit a
comprehensive implementation report after three years. Sections four and
five provide for severability and a delayed effective date with authori-
zation for advance regulatory implementation.
 
JUSTIFICATION:
In 2025, the Governor vetoed prior legislation addressing pharmacy
access concerns, citing the need to avoid statutory rigidity, preserve
regulatory discretion, and prevent unintended cost or administrative
impacts. This bill directly responds to those concerns. Rather than
creating new substantive rights or mandates, the bill codifies existing
Board regulations, incorporates objective and time-based standards, and
expressly defers to Board authority where regulations provide equal or
greater protections.
Timely access to prescription medication is critical to recovery and
system efficiency. Delays increase medical complications, prolong disa-
bility, and generate avoidable disputes. By aligning statute with
current regulations, this bill ensures consistency, permanence, and
enforceability while reducing litigation and administrative burden.
Importantly, the bill balances access with accountability by requiring
strict compliance with fee schedules and formularies and by placing
financial risk on pharmacies when claims or medications are not compens-
able. This approach protects employers and carriers while ensuring
injured workers are not left without medically necessary treatment due
to administrative delay.
 
LEGISLATIVE HISTORY:
2025: 54926 (Ramos) - Vetoed
2024: S 1974-A (Ramos) - Vetoed
 
FISCAL IMPACT:
To be determined
 
EFFECTIVE DATE:
This act shall take effect on the sixtieth day after it shall have
become a law.