White Paper

The Unintentional Impact of PBM Legislation on Workers’ Compensation

What’s good for group health may not be good for workers’ comp. MyMatrixx expert, Adam Fowler, explains how broad PBM legislation can lead to negative consequences for workers' comp.

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.

To learn more about myMatrixx, please visit their website.

As a PBM focused on workers’ compensation, MyMatrixx is dedicated to highly proactive customer support and a full suite of data-driven pharmacy, clinical and regulatory solutions to mitigate risk and safely guide injured workers on their path to recovery.

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