In their 2026 state legislative sessions, state legislators have continued considering bills targeting pharmacy benefit managers (PBMs). These bills seek to further regulate pharmacy services in the broader insurance market and, if passed and signed into law, could have significant impact on pharmacy costs, add administrative burden, and require significant contractual changes. In addition, several of these bills would conflict with existing state workers’ compensation laws as outlined below.
Oklahoma
Two Oklahoma bills that would conflict with the state’s workers’ compensation law advanced out of the first chamber (Senate) in late March and are pending in the House.
Senate Bill 2074 would mandate a minimum reimbursement to pharmacies that, in part, would include a minimum dispensing fee that is over twice the existing workers’ compensation law’s maximum dispensing fee.
Senate Bill 1500 would add a required − and shorter − provider payment timeframe, which conflicts with the workers’ compensation law’s required provider timeframe for PBMs and all “payers” (broadly defined).
Additionally, Oklahoma House Bill 3538 was substituted in late March to include a minimum pharmacy reimbursement requirement. Similar to SB 2074, this conflicts with the existing workers’ compensation pharmaceutical fee schedule. HB 3538 passed the House and is pending in the Senate.
Minnesota
Minnesota had three bills referred to their first committees in early March.
House File 3931 and Senate File 4062 would require PBMs to reimburse pharmacies at no less than the National Average Drug Acquisition Cost (NADAC) for the drug, or the Wholesale Acquisition Cost (WAC) if NADAC is unavailable. This mandated minimum reimbursement conflicts with the state’s workers’ compensation pharmaceutical fee schedule and could override the existing Medicaid maximum allowable cost (MAC)-based pricing reimbursement structure, impacting drug costs.
House File 4140, would set pharmacy reimbursement at NADAC (or WAC if NADAC is unavailable), plus 4% or $50 (whichever is less), plus a dispensing fee equal to Minnesota’s Medicaid professional dispensing fee, which is currently $11.55.
This conflicts with the state’s workers’ compensation pharmaceutical fee schedule, which includes a $3.65 dispensing fee for electronically adjudicated transactions.
Mississippi
Without achieving concurrence between the chambers, Mississippi House Bill 1665 eventually failed. In two ways, this bill would have conflicted with existing state worker’s compensation law by:
- Implementing a new pharmacy minimum reimbursement
- Reinforcing different provider payment timeframes
The White House intervened in this after the Senate added an amendment to mandate the reimbursement minimum. The White House Offices of Domestic Policy and Intergovernment Affairs sent a letter on March 18, which asserted the bill’s Senate-amended version could “complicate the President’s policy and priority of providing access to the lowest prices on prescription medications for every American” and encouraged the Mississippi House to not concur. The legislature adjourned on April 3 without any PBM bills advancing to the governor. However, we continue to hear rumors that the House Speaker and sponsors of HB 1665 are working on a compromise that could be addressed in a special legislative session.
Idaho
As one other example, Idaho Senate Bill 1367 would have mandated a new minimum pharmacy reimbursement rate based on the NADAC of the drug (or the WAC if NADAC is unavailable) plus a minimum $12.35 dispensing fee (subject to an annual increase) that would apply regardless of the pharmacy’s agreed-upon contractual rates. This would have conflicted with the existing workers’ compensation pharmacy fee schedule, which has a maximum dispensing fee of $5 for brand drugs and $8 for generic drugs. This means the bill would have also likely increased costs. SB 1367 was introduced in early March and referred to the Senate Commerce and Human Resources Committee, but it did not progress further by the end of this year’s regular legislative session, which adjourned in early April.
MyMatrixx is tracking it all
The MyMatrixx Regulatory Affairs team is tracking over 300 bills specifically targeting PBMs. While many of the bills do not legally apply to workers’ compensation PBMs, the language within them tends to be overly broad and fails to account for the unique nature of workers’ compensation insurance. Thus, we have seen – and will probably continue to see – more instances of unintended conflicts in proposed PBM legislation.
MyMatrixx, in conjunction with our corporate State Government Affairs team and our trade associations, engages where appropriate to ensure good public policy for our industry. We have built relationships with state workers’ compensation regulators and continue to educate policymakers on the differences in workers’ compensation and the consequences and conflicts these broad PBM bills may have, particularly for medication reimbursement.
For more information on the legislation we are tracking across the country, visit the Legislative and Regulatory Policy Tracker on our Statehouse Watch webpage where you can sort bills (or regulations) by topic and state. To focus on PBM bills, select “PBM Regulation” as the topic. Questions for our Regulatory Affairs team can be sent to MMXRegulatoryAffairs@MyMatrixx.com.
*Notes:
- The status and content of legislation can change quickly and often during an active legislative session. The bill information noted above may have changed by the time you are reading this.
- Nothing in this content should be considered legal advice nor should it be construed as such.