Early in 2026, several states have introduced legislation that targets pharmacy benefit managers (PBMs) and seeks to further regulate pharmacy care in the broader insurance market and, at times, workers’ compensation. If passed and signed into law, the new laws could have significant impact on workers’ compensation PBMs and their payer clients by increasing costs, adding administrative burden, requiring significant contract changes, and reducing access to pharmacy care for injured workers.
The MyMatrixx by Evernorth Regulatory Affairs team has outlined some of the newly introduced bills and their potential impact on workers’ compensation pharmacy.
Commercial health language conflicting with workers’ comp law
A recent, concerning trend with PBM legislation has been its unintended consequences for the workers’ compensation industry. PBM legislation is primarily intended to regulate commercial health insurance where patients have cost share and there is less regulation in place. Unless a state expressly exempts workers’ compensation from bills, the overbroad or vague language in PBM legislation can sometimes unintentionally impact workers’ comp.
Here are some examples of new PBM legislation that could conflict with existing workers’ comp laws:
· Hawaii HB 2225 would potentially expand the scope of the existing state PBM law to include workers’ comp given some of the terms and definitions it proposes to add. As written, the language of the bill would add a mandatory minimum payment to pharmacies of no less than the “national average drug acquisition cost” (NADAC) for a drug in addition to a dispensing fee at the same rate as required under the state’s Medicaid fee schedule. In conflict is the state’s current workers’ comp law, which already regulates pharmacy reimbursement by establishing a maximum fee schedule with no mandatory dispensing fee.
· Mississippi HB 1665 would perpetuate different payment response and processing timeframes to pharmacy providers for electronic and paper bills that would conflict with the standard timeframes required under the state’s workers’ compensation law.
· Oklahoma SB 2074 would add a mandatory minimum payment to a provider of no less than the NADAC for a dispensed drug and a dispensing fee of no less than the state’s Medicaid dispensing fee rate, which is currently set at $10.87. The state’s workers’ comp law already regulates provider reimbursement by establishing a pharmaceutical fee schedule. The bill’s proposed minimum dispensing fee would conflict with and be more than double the maximum dispensing fee already permitted under that workers’ comp fee schedule, likely increasing the costs for medications in the system.
· Oklahoma SB 1500 would require payers to pay pharmacy providers within 30 calendar days. That timeframe conflicts with the 45-day payment required timeframe under the state’s workers’ compensation law. This bill also proposes late payment penalties that may also conflict with penalties prescribed in the workers’ comp law.
Provisions that would impact contractual pricing and provider access
Beyond the above conflicts, PBM legislation can also have a major impact on the provision of general pharmacy care for multiple markets.
For example, multiple bills introduced this year would limit contractual options that PBMs and their payer clients would have for both drug pricing and the handling of rebates, including in workers’ compensation claims. Bills of potentially greater note for workers’ comp include Hawaii HB 2225, Mississippi HB 1665, West Virginia HB 5430/SB 907, and New Hampshire SB 547.
Other bills would prohibit PBMs from owning pharmacies within certain states. This type of prohibition can reduce competition and limit employer and patient (injured worker) access to more affordable medications though PBM-affiliated home delivery pharmacies. Examples of bills like this include New York S 9191, Oklahoma HB 4457, and Tennessee HB 1959/SB 2040.
MyMatrixx is tracking it all
The MyMatrixx Regulatory Affairs team has added nearly 200 new PBM bills to our tracking database since December 1, 2025, with more likely to come. While many of these bills would not legally apply to workers’ compensation PBMs, several will and future amendments to some bills may put workers’ compensation in scope. MyMatrixx, in conjunction with our corporate State Government Affairs team and our trade associations, will engage where appropriate and advantageous to ensure good public policy for our industry, as we continue to educate policymakers on the differences in workers’ compensation and consequences these bills may have.
For a view of 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.