Legislative roundup: VBMs, ODs clash in HB 1696 lawsuit; safety alert issued for vision-testing kiosk in Pennsylvania

It has already been a busy year legislatively thus far for eye care providers across the country. From the striking down of house bills to the issuance of safety alerts, here are the latest legislative updates that pertain to optometrists:

Texas

A ruling out of the US District Court of the Northern District of Texas blocking aspects of HB 1696 has spurred divided reactions from vision benefit managers (VBM) and optometric advocacy organizations.¹ The lawsuit that spurred the ruling argued that the bill would “impose unconstitutional restrictions on the ability of vision care companies to freely promote, advocate, and encourage annual vision care visits; limit consumer value and choice by restricting how plans communicate savings, offers, and lower cost options; and make it harder for Texans to access care by preventing plans from identifying participating providers who offer cost effective services.”² The lawsuit was filed by the Healthy Vision Association in partnership with the National Association of Vision Care Plans (NAVCP), VSP Vision™, and Visionworks® in August 2023,² shortly after the bill was signed in June 2023 by the governor and set to go into effect in September 2023.³

“This decision is a resounding win for Texans,” said VSP Vision President and CEO Michael Guyette, in a VSP news release.² “By upholding the right of consumers to make their own informed decisions, this ruling empowers individuals to access affordable, high-quality eye care and eyewear in a destination that best suits their needs.”

“We applaud this decision as it keeps patients first,” said Rich Schindehette, president of the Healthy Vision Association, and member of the Alliance for Affordable Vision Care (AAVC) in an AAVC release.⁴ “Vision care patients deserve straightforward, factual information about how to use their vision benefits. When families have access to information about all their options, they can make choices that benefit their health and finances.”

However, the Texas Optometric Association (TOA) argued in a statement that the “ruling undermines Texas’ efforts to curb monopolistic behaviors in the vision benefits industry that drive up costs, limit provider networks, and erode patient choice and access.”

“HB 1696 was enacted to address longstanding anti-competitive practices by certain managed vision care plans and VBMs,” the TOA continued. “These practices have included patient steering toward specific providers (often corporate-owned or corporate-affiliated locations), unethical tiering of doctors based on financial incentives, restrictive controls over independent practices, and other tactics that prioritize corporate profits over patient choice, doctor-patient relationships, and access to local eye care.”

“Texas optometrists, who provide the majority of primary eye care in the state, intervened in the lawsuit alongside the State of Texas to defend HB 1696. We believe the statute's restrictions on conduct by VBMs were narrowly tailored to prevent deceptive steering and protect vulnerable consumers, consistent with the state's authority to regulate insurance and health care markets for the public good.”

Additionally, American Optometric Association (AOA) President Jacquie Bowen, OD, declared in a statement that the organization is prepared to continue to head legislative initiatives to see HB 1696 out. “It seems the Vision Benefit Middleman (VBM) industry is pointing to a temporary reprieve through the courts for thoroughly anti-patient, ‘steering and tiering,’ tactics, a result of their 2 years of legal warfare targeting the Texas Department of Insurance and legislature, the TOA and a provision of the state’s comprehensive 2023 VBM reform law,” Bowen said in the statement. “What they refuse to discuss is resolving patient and doctor complaints and the growing nationwide momentum for VBM accountability. That’s why AOA and affiliate efforts will continue to advance state legislation, federal legislation and Congressional and government agency investigations focused squarely on abusive VBM policies, while continuing to expose an out-of-control industry that appears to invest in lawyers, lobbyists and loopholes instead of patient care, health awareness and doctor-patient decision-making.

“If holding VBMs accountable requires sustained legal and legislative action, we are prepared. Through the AOA’s Stop Plan Abuses initiative alone, more than $12 million has already been restored to doctors and their practices from wrongful denials and payment refusals – real results that underscore why this work will continue.”

Pennsylvania

The Pennsylvania Optometric Association (POA) has issued a statewide patient safety alert regarding Eyebot, an automated vision-testing kiosk operating in 16 Walmart and Sam’s Club locations across Pennsylvania as part of a pilot program.⁵

The POA and the AOA state that the kiosks’ 15-minute autonomous vision tests are not a substitute for comprehensive, in-person eye exams and warn the technology may discourage patients from seeking routine care. POA President Erin Draper, OD, said the organization supports innovation that improves access but opposes kiosk refractions because they do not provide a comprehensive exam and may create a false sense of reassurance about ocular health. The alert notes that delaying routine care could increase the risk of undiagnosed conditions and widen health care disparities.⁵

According to the POA, Eyebot installations in other states have prompted complaints to state regulators, the Federal Trade Commission (FTC), and the Food and Drug Administration (FDA). Eyebot, which emerged in New England in 2024, advertises 90-second “vision tests” and doctor-reviewed eyeglass prescriptions through a partnership with Zenni Optical, offered free with the purchase of glasses priced at $49 or more.⁵

The AOA has called for federal review of the technology and raised concerns about potential violations of the FTC’s Eyeglass Rule, which requires patients receive a copy of their prescription before being offered eyewear for sale. In 2025, the AOA updated its telemedicine policy to state that direct-to-patient technology should not replace comprehensive eye exams or diagnostic care and said it will continue monitoring the issue.⁵

Arkansas

The Arkansas Optometric Association (ArOA), supported by the AOA, is challenging EyeMed’s actions following the passage of Arkansas’ Act 142, a VBM accountability law enacted in 2025.⁶

In October, EyeMed directed hundreds of Arkansas optometrists to sign a “new” provider agreement within 30 days “to stay in compliance with Act 142.” ArOA said EyeMed’s interpretation of the law was unsupported and requested written clarification, documentation of contract changes, and assurances that providers would not be removed from the network. The association reported that EyeMed initially declined to provide written responses and later offered limited verbal explanations during a phone call.⁶

During that call, EyeMed Vice President of Doctor and Provider Relations Pete Kehoe, OD, said core provider agreement language had not changed and that Act 142 compliance was addressed through existing provisions and modified appendices. He also said EyeMed does not believe Medicare-based reimbursement requirements apply to “routine eye” exams and that doctors who signed agreements had “accepted” non-Medicare reimbursement rates.⁶

ArOA leaders disputed those claims, stating that Act 142 established Medicare-based reimbursement as a floor for covered services. Executive Director Matt Burns said EyeMed has not provided written documentation supporting its compliance assertions and that many doctors reported feeling pressured to sign agreements under threat of network removal. At a November ArOA town hall, 91% of optometrists who received the email reported feeling pressured to sign.⁶

According to the release, other VBMs in Arkansas have updated reimbursement rates to comply with Act 142. The AOA said it will continue to advocate for VBM reforms through federal legislation, congressional investigations, and direct plan advocacy.⁶

South Carolina

The South Carolina Supreme Court has unanimously upheld a state law banning online-only vision tests for prescription renewals, ruling that the prohibition does not violate the state constitution. The decision ends a nearly decade-long legal challenge by Visibly, a Chicago-based telehealth company formerly known as Opternative, which offered remote vision tests reviewed by licensed eye doctors.^7,8

The law, backed by the South Carolina Optometric Physicians Association and in effect since 2016, requires patients to undergo in-person eye exams, effectively barring Visibly’s model. Then-Gov. Nikki Haley vetoed the measure, but the legislature overrode the veto. Visibly argued the law was unconstitutional and discriminated against telehealth, while the state defended it as necessary to “protect the public from receiving inadequate eye care,” citing the importance of comprehensive in-office exams for detecting conditions such as glaucoma, cataracts, and macular degeneration.⁸

Visibly attorney Joshua Windham criticized the ruling as favoring an outdated business model, saying it “was tailor made to destroy one company.” Justice John Few noted that prescribing corrective lenses without physically examining a patient differs fundamentally from other telemedicine practices. The court suggested lawmakers may revisit the law as technology continues to evolve.⁸

References:

1. Case 5:23-cv-00167-H. United States District Court Northern District of Texas Lubbock Division. Healthy Vision Association et al v. Abbott et al. February 19, 2026. Accessed March 2, 2026. https://docs.justia.com/cases/federal/district-courts/texas/txndce/5:2023cv00167/379919/110

2. Federal court blocks Texas HB 1696, delivering major win for vision care consumers and providers. News release. VSP Vision Care. February 23, 2026. Accessed March 2, 2026. https://www.vspvision.com/newsroom/company-news/company-announcements/Federal-Court-Blocks-Texas-HB-1696-Delivering-Major-Win-for-Vision-Care-Consumers-and-Providers

3. Texas optometrists mount defense in court and legislature of landmark law on vision plan abuses. News release. American Optometric Association. February 27, 2025. Accessed March 2, 2026. https://www.aoa.org/news/advocacy/state-advocacy/texas-optometrists-mount-defense-in-court-and-legislature-of-landmark-law-on-vision-plan-abuses

4. Alliance for Affordable Vision Care applauds decision protecting access to affordable vision care. News release. Alliance for Affordable Vision Care. February 23, 2026. Accessed March 2, 2026. https://www.affordablevisioncare.org/press-releases/alliance-applauds-decision-access-to-affordable-vision-care

5. Pennsylvania Optometric Association issues patient safety alert for eye exam kiosk pilot. News release. American Optometric Association. January 15, 2026. Accessed March 2, 2026.

6. Arkansas doctors rallying for full implementation of new VBM accountability law. News release. January 15, 2026. Accessed March 2, 2026.

7. Case 2024-001321. Appeal from Richland County Kristi F. Curtis, Circuit Court Judge Opinion No. 28310. January 21, 2026. Accessed March 2, 2026. https://www.sccourts.org/media/opinions/HTMLFiles/SC/28310.pdf

8. Holdman J. SC Supreme Court upholds ban of online eye exams for glasses, contact lenses. South Carolina Daily Gazette. January 21, 2026. Accessed March 2, 2026.