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Workers Compensation Used
to be About Helping Injured Workers
The workers' compensation system was designed so that injured workers could get the medical benefits they required quickly so they could heal and return to work. Employers are responsible to pay for this. In return, they cannot be sued for workplace injuries. Unfortunately, the system is heavily in favor of the employers and their insurance carriers and has become more bureaucratic than ever. New York has turned a blind eye to the systematic deterioration of the servicing of the injured workforce. A decade of evidence has demonstrated that the reforms put in place only further crippled the system. Fast forward to today’s workers’ compensation system, where Insurance Carriers can designate Pharmacy Benefit Managers (PBMs) as a monopoly network for injured workers’ prescriptions. The contractual details are hidden behind a veil of propriety information and there is no price transparency disclosed. Since the 2007 reforms, there was an explosion in prescription costs in the system, all while the Insurance Carriers used the PBMs. Smaller pharmacies are cut out and under New York State Workers’ Compensation law injured workers can be forced to use only the pharmacies dictated by the insurance carriers. Injured workers with contested cases find they have no access at all to prescription medications. Granted a monopoly, the insurance carriers routinely deny access to medications for injured workers, especially injured workers whose claims are contested. The state has already enacted price controls, treatment guidelines, and drug formulary controls. There is no reason not to allow the injured worker their choice of New York State pharmacy when the designated network fails them.
Countless injured workers are denied pharmacy benefits every year.
Low wage earners are the most vulnerable
Cost savings is impossible to calculate because giant corporations refuse to share information with the government
Many of these workers are women and people of color
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Protect injured worker healthcare