Arizona House Bill 2813 was introduced, proposing new regulations for benefits in the workers' comp system that will effectively allow organizations to direct their injured workers to their contracted pharmacy network.

The legislation enables employers or insurers who have established a formal pharmacy management network to issue notice requirements to injured workers. At the time of reported injury, employers or insurers may notify injured workers on how to use the pharmacy management network and they must provide a list of network pharmacies, either in print or electronically.

Out-of-network prescriptions would be reimbursed at the pharmacy fee schedule amount, until the payor or pharmacy management network provides notice to the out-of-network pharmacy that the injured worker is required to receive prescriptions from an in-network pharmacy, and that future medication refills from the out-of-network pharmacy will not be reimbursed. However, assuming the out-of-network pharmacy is licensed, in good standing, and willing to abide by the pharmacy management network’s contract terms, they may be invited to join the network.

If a claim is disputed for compensability, injured workers are not required to use a pharmacy within the network until the dispute is resolved and the pharmacy management network provides notice to the parties that the claim is accepted.

If passed, the bill would go into effect on January 1, 2027.

Healthesystems will support and engage with legislators to assist in passing this legislation, which is anticipated to deliver positive results for injured workers in terms of the quality of care, and increase cost savings for the payer community.