Direction of pharmacy care legislation gives carriers, insurers, and pharmacy benefit managers (PBMs) complete control over where injured workers obtain their prescriptions. These proposals, in states like Arizona and Georgia, carry the same message: limit patient choice, expand PBM control.
For anyone who works with injured workers, the impact is obvious. Direction of care does not help patients. It helps PBMs, an industry facing bipartisan scrutiny, federal investigations, and growing evidence of anti-competitive behavior. However, when these bills pop up, states like Arizona and Georgia already operate strong, stable, low-cost workers’ compensation systems. The data shows the legislation is unnecessary. The performance of the state workers’ compensation systems proves that out. Let’s break down what’s happening.
Direction of pharmacy care is the wrong direction
Direction of care would allow insurers and PBMs to steer patients into closed pharmacy networks, cutting off trusted providers, and reducing choice. It empowers an industry already under fire. These cases may come from healthcare, but they point to a bigger problem: PBMs behave like bad actors across every market they operate in, and workers’ compensation is no exception:
- The FTC forced Express Scripts to overhaul opaque, rebate driven practices that kept insulin prices artificially high and limited access to lower cost alternatives, clear evidence of PBMs putting profit over patients.
- Congress enacted the CAA 2026/HR 7148 to force 100% rebate passthrough and full compensation transparency, because PBMs were withholding critical financial information from employers, plans, and regulators.
- Highly Concentrated Market: AMA’s review of 2022 commercial and government report data show the PBM market has minimal competition: CVS Caremark controls 21.3% and OptumRx 20.8%. Concentration worsens the risk of steering and limited options.
- States have passed more than 220 PBM related laws since 2016, and even Congress requested DOJ investigations into PBMs’ alleged role in steering patients toward certain opioids in exchange for rebates.
This is the industry managed care proponents seek to embolden.
Arizona
Representative Livingston introduced HB 2813, which would amend Arizona’s workers’ compensation laws to allow employers to establish pharmacy management networks for providing medications to injured employees. Arizona, however, has long been recognized as having one of the strongest, most efficient, and lowest cost workers’ compensation systems in the nation. That raises a fundamental question of what problem is HB 2813 trying to solve?
Arizona’s system works
- Ranked 8th lowest cost per employee nationwide
- Spends just $0.87 per $100 of payroll, far below high-cost states such as California, Minnesota, and New York
- Premiums decreased for 12 consecutive years, including a 6.7% drop for 2026
- Governor Hobbs’s FY2027 Executive Budget praises the system’s efficiency and steady improvements
First Responders are sounding the alarm
Arizona’s fire and police organizations opposed HB 2813 because direction of pharmacy care would:
- Delay access to medications
- Disrupt continuity of care
- Limit access to specialized pharmacy partners
Ultimately, HB 2813 never made it out of either Committee. First, it was withdrawn from the Health Committee because the Chair did not think there were enough votes. It then failed to advance through the Appropriations Committee, even though the sponsor served as chair.
Georgia
Georgia’s workers’ compensation system has also been performing exceptionally well. And yet, four members of the Georgia House of Representatives introduced HB 1119, which proposes direction of care—again, without a clear problem it aims to solve.
Georgia’s system is affordable and stable
- 13th lowest cost per employee nationwide
- Spending just $1.15 per $100 of payroll
- NCCI’s latest filing proposals: 8.8% voluntary loss costs, −9.3% assigned risk rates for 2026
Update: HB 1119 was pulled from the legislative process
HB 1119 is no longer moving through the legislature. Instead, it shifted to the State Board of Workers’ Compensation for review and recommendations. This means there is not a bill to consider in 2026, and workers, providers, and employers avoid a rushed, unnecessary statutory change.
Direction of care is not the norm
When you zoom out and look at state workers’ compensation systems, one theme becomes impossible to ignore: most states prioritize allowing injured workers to choose their own pharmacy.
Today, 12 states explicitly prohibit direction of pharmacy care; 14 states permit it, but with restrictions, and just 3 states: California, New York, and Minnesota, allow full direction of care.
If only three states embrace this level of employer /insurer driven control, it raises an important question: Why are others trying to follow suit? At its core, workers’ compensation is meant to be patient centered. States have long recognized protecting patient choice, limiting PBM influence, and ensuring access to trusted providers leads to better outcomes, faster recoveries, and a more balanced system.
The Results Speak for Themselves
Despite being introduced:
- Georgia’s HB 1119 was pulled entirely from the legislative process
- Arizona’s HB 2813 failed in committee—even with the Appropriations Chair as the lead sponsor
In both states, lawmakers deemed direction of care as the wrong prescription. Workers, providers, and first responders all voiced concerns, and lawmakers listened. Providers and injured workers should remain optimistic. Even though these bills may surface again, every time they do, the evidence supporting choice must prevail.