As policymakers across the country debate legislation to regulate Pharmacy Benefit Managers (PBMs), many bills include provisions on patient cost sharing, rebates, and formulary transparency in commercial health insurance. However, overly broad language may unintentionally impact workers’ compensation, creating legal conflicts, regulatory uncertainty, and increased costs.
In this WorkComp Wire Partner Post, Adam Fowler, MyMatrixx by Evernorth Director of Regulatory Affairs, explains why workers’ compensation is fundamentally different from group health insurance and how applying commercial pharmacy benefit concepts to workers’ compensation can conflict with existing statutes and disrupt systems designed to support timely care and return‑to‑work outcomes.
He describes which states have taken action to exclude workers’ compensation from their PBM reform legislation and provides recommendations to policymakers to protect the objectives of workers’ compensation systems.
Nothing in this message is intended to be construed as legal advice nor can it be construed as such.