So far in 2025, there have been several proposed pieces of legislation in states related to pharmacy and other health care provider networks in workers’ compensation. MyMatrixx by Evernorth is tracking several of these bills related to pharmacy and physician choice, which could impact the ability of our clients to direct pharmacy and medical care.
Pharmacy Choice
There are four pharmacy choice bills pending in New York: Senate No. 4926, Assembly No. 6887, Assembly No. 3859, and Senate No. 306. All these bills would steer the law in favor of injured worker choice versus employer/insurer choice.
Senate No. 4926 and Assembly No. 6887 would allow injured workers to go out of a designated pharmacy network when an employer or insurer refuses to provide payment and the injured worker is unable to obtain the medication from a network pharmacy due to:
- Failure of the employer or insurer to authorize within 72 hours
- Failure of the employer or insurer to reauthorize within 72 hours for one or more of several listed reasons.
S 4926 was introduced in February and passed the Senate Labor Committee, while A 6887 was introduced in March and is awaiting action in the Assembly Labor Committee.
Both bills are similar to a bill that passed out of chamber last year but was vetoed by the governor stating the bill would:
- Increase litigation
- Add bureaucratic steps for the New York State Workers’ Compensation Board (WCB)
- Lead to delays in obtaining needed medication
The governor also referenced proposed regulation changes from the WCB that would provide a process for out-of-network pharmacy use in situations when a condition or injury has not been established or there is another legal objection. The governor said those proposed regulation changes seek to accomplish the intent of the bill and more efficiently address concerns without causing delay. The MyMatrixx by Evernorth Regulatory Affairs team submitted written comments on those proposed changes, which are still pending in the rulemaking process.
Assembly No. 3859 would change the current law provision that allows an employer or carrier to “require” use of a pharmacy network changing it to simply “encourage” use. The bill also states that injured workers may use non-network pharmacies if the pharmacy is registered as a resident, in-state pharmacy and the medications are casually related to the claimant's work-related injuries (non-resident, out-of-state pharmacies and compound medications would be excluded).
Senate No. 306. would entitle an out-of-network pharmacy providing causally related medications to an injured worker to be reimbursed at the same rate negotiated between the workers’ compensation carrier and the carrier’s established pharmacy network if that network provides mail-order service or is located within a reasonable distance from the injured worker.
Both A 3859 and S 306 were introduced in January and are still in their original chambers’ Labor committees awaiting action.
One bill that has failed to progress through the legislative process this session was Arizona House Bill 2429. This bill took the opposite approach of New York by permitting an employer to establish a “pharmacy management network” and require their injured workers to obtain medications through that network. The bill would have also required:
- An employer to notify employees of the network and to register the network with the Industrial Commission.
- Third-party billers to be reimbursed only at the contractual amount agreed by that network pharmacy.
The bill was introduced in mid-January and referred to two committees, with no subsequent action.
Physician Choice
Physician choice is also a topic of several pieces of legislation this year. We have been tracking bills in Arkansas, California, Colorado, Indiana, Iowa, Kansas, Montana, and Nevada that could have an impact on the ability of our clients to direct medical care, including the choice of treating physicians who prescribe medications to injured workers. For more on those and their current status, many which favor injured worker choice, we encourage review of our Legislative & Regulatory Tracker (select “Workers’ Compensation” as the category and “Direction of Care” as the topic).
More
The MyMatrixx by Evernorth Regulatory Affairs team tracks and monitors newly introduced and pending legislation and regulations across the country. You can visit our Statehouse Watch webpage for updates on other topics. Questions for our Regulatory Affairs team can also be sent to MMXRegulatoryAffairs@MyMatrixx.com.