You’ve probably heard the idea, “Even the flutter of a butterfly’s wings can cause a hurricane on the other side of the world.” It’s called the butterfly effect, and it promotes the idea that everything matters and can have an impact. While not as delicate as butterfly wings, the same idea is true for the influx of proposed legislative changes and their potential impact on workers’ compensation and pharmacy care. 2025 has been another busy year for these state-by-state changes that may impact how claims are handled, what conditions and treatments are compensable, and how medical/pharmacy services are billed, reviewed, and reimbursed. Even provider contracting terms, network requirements, and pricing options between insurers, employers and their health care provider networks or PBMs can be impacted.
In a recent WorkCompWire Leaders Speak, Adam Fowler, MyMatrixx by Evernorth’s Director of Regulatory Affairs, breaks down some of the notable legislative actions in 2025 on topics including:
- Fee schedules and pricing
- Presumptive or special coverage
- Direction of care
- Reviewing medical treatment or medical bills
- Pharmacy benefit manager (PBM) legislation
Click to read more about which states are legislating these topics and the impact they will have on workers’ compensation claims.