In a long-awaited decision, on February 25, 2026, the First District Court of Appeal in Florida issued an opinion that invalidated physician dispensing regulations previously adopted by the Florida Division of Workers’ Compensation (DWC). In doing so, the court declared that physicians are not pharmacists under the state law, in a state which permits injured workers the free choice of pharmacist. The ruling has implications for:
- Injured worker choice
- Payer authorization
- Provider reimbursement
The saga of physician dispensing in Florida
This ruling is the latest development in the controversial topic of physician dispensing in the state’s workers’ compensation system. That history is important for context.
While physicians (referred to as dispensing practitioners in the law) may legally dispense medications in Florida to their patients under some conditions and limitations, the Florida workers’ compensation law requires a medical provider providing non-emergency services in a workers’ compensation claim to receive authorization from the insurer before providing treatment. A notable exception within the workers’ compensation law gives injured workers “free, full, and absolute choice in the selection of the pharmacy or pharmacist dispensing and filling prescriptions for medicines.” Historically, the DWC interpreted the latter “absolute choice” provision to not apply to dispensing practitioners. Given this, some payers in the system were using the law as grounds to not authorize and reimburse dispensing practitioners.
Then in 2020, the DWC published an informational bulletin stating its changed position that payers cannot deny authorizing or reimbursing providers just for being dispensing practitioners. The DWC’s new position interpreted the law to mean that injured workers “have the right to choose to have their prescriptions dispensed by a dispensing practitioner as authorized in Florida law.” Payer groups challenged that shift in DWC opinion for legal reasons and a resulting settlement agreement called for the DWC to rescind the bulletin and engage with stakeholders in rulemaking on the topic.
Subsequently, the DWC rescinded the bulletin, but they eventually adopted new rules in 2023 for dispensing practitioner authorization and reimbursement that continued with the same opinion that insurers may not deny authorization or reimbursement simply because the provider is a dispensing practitioner. The rules stated in part, “Dispensing such medication may not be denied, absent a contrary contractual provision, and reimbursement may not be disallowed or adjusted for the sole reason that the injured worker has chosen to receive such medication from a practitioner registered to dispense medications.” Payer groups challenged these rules by filing an administrative petition stating them as invalid exercises of delegated legislative authority. Following a hearing, the Division of Administrative Hearings (DOAH) issued an order rejecting their claims and dismissing the petition.
The long-awaited ruling
In 2023, the issue was appealed to the First District Court of Appeal in “Publix Super Markets, Inc., Normandy Insurance Company, et al v. Department of Financial Services, Division of Workers Compensation, et al.” On February 25, 2026, that court finally issued its initial opinion, which invalidates the DWC’s practitioner dispensing rules, stating they “improperly enlarge, modify, or contravene [the pharmacist choice provision in the law] and are an invalid exercise of delegated legislative authority.”
Simply, the opinion concludes that dispensing practitioners are not pharmacists. While the law gives injured workers ‘absolute choice’ and they are entitled to choose their own pharmacy or pharmacist, “Dispensing practitioners do not fit within the plain meaning of ‘pharmacist’, nor do they engage in the ‘practice of the profession of pharmacy.’”
Ramifications and next steps
As noted, this ruling has implications for injured worker choice of dispensing practitioners and payer authorization and reimbursement of those practitioners. The ruling contradicts and reverses course on the 2020 and 2023 DWC position on this issue. Given that, the DWC may communicate further on this and/or take additional action. It is also important to note that the appellees in this case (various dispensing physician interests) could file a motion for rehearing or attempt to appeal the decision. Individual insurers and employers, as the parties responsible for compliance, should assess the potential impact of this latest ruling on how they are currently managing the authorization and reimbursement of dispensing practitioners, consulting their own legal counsel given this involves a controversial litigated matter.
More policy updates
For more information on other public policy developments in workers’ compensation impacting pharmacy across the country, please visit and bookmark Statehouse Watch at MyMatrixx.com. Send your regulatory or public policy questions on this topic or others to our Regulatory Affairs team at MMXRegulatoryAffairs@MyMatrixx.com.