White Paper
The Unintentional Impact of PBM Legislation on Workers’ Compensation
White Paper Summary
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 article, 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.
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