On June 16, 2026, the Pennsylvania Supreme Court ruled that the Workers’ Compensation Act’s anti-referral provision does not prohibit physicians from referring injured workers to pharmacies in which they have a financial interest.

The case came about when injured workers received medications from a prescriber-affiliated pharmacy, and the payer refused to reimburse the medications, arguing that the self-referrals were unlawful. An earlier Commonwealth Court ruling sided with the payer, which held that the statute’s reference to “goods and services” included prescription drugs and pharmacy services within the anti-referral prohibition. The Supreme Court disagreed and concluded that the law does not extend to pharmacy referrals.

Based on the Court’s interpretation, any expansion of the restriction to include pharmacy referrals would require changes to the statutory language.

Payers must review existing reimbursement policies and denial practices related to physician-owned pharmacies. Following this decision, payers may no longer rely on the anti-referral provision as the sole basis for denying reimbursement for prescriptions dispensed by physician-owned pharmacies.

The decision may spark a legislative effort to address the outcome of the case and Healthesystems will be closely engaged and report on new developments.