Recent legislative and regulatory activities impacting workers' compensation pharmacy in AK, CA, IL, and MS
The MyMatrixx by Evernorth Regulatory Affairs team tracks and monitors legislation and regulations impacting workers’ compensation pharmacy nationwide. You can follow what's happening state-by-state with our online tracker.
Alaska moves draft fee schedule changes forward
On August 7, 2026, the Alaska Workers’ Compensation Division’s Medical Services Review Committee reviewed the latest potential updates to the state’s medical fee schedule including language that addresses physician dispensing, topicals, and compounds. The committee also considered language recommendations from MyMatrixx by Evernorth regarding closing gaps for certain over-the-counter medications and clarifying where dispensing or compounding fees would apply to pharmacies. The MyMatrixx Regulatory Affairs team also previously provided information on what other states have done to address some of those topics.
The committee is also considering fee schedule changes beyond pharmaceuticals.
A joint meeting to review any final committee-recommended changes with the Alaska Workers' Compensation Board is scheduled for August 28, 2026. If advanced forward, a formal rulemaking and comment period would follow with adopted fee schedule changes likely taking effect January 1, 2027.
California treatment guidelines updated
The California Division of Workers’ Compensation (DWC) adopted updates to its Medical Treatment Utilization Schedule (MTUS) treatment guidelines, for services rendered on or after August 1, 2026. The updates incorporated the following updated American College of Occupational and Environmental Medicine (ACOEM) guidelines:
- Ankle and Foot Disorders Guideline (ACOEM January 29, 2026)
- Hip and Groin Disorders Guideline (ACOEM January 29, 2026)
Adopted MTUS guidelines are presumed to be correct on the issue of extent and scope of medical treatment and are intended to guide provision and authorization of treatment in the state’s workers’ comp system.
Illinois UR law amended
Illinois House Bill 5228, signed into law on August 7, 2026, amends the workers’ compensation law to require utilization review (UR) denials and appeal reviews be conducted by physicians or providers with the same professional licensure as the recommending provider. The bill, which became effective upon becoming law, also:
- Establishes a formal appeal process for non-certifications
- Makes treatment approvals valid for at least three months (including certain postoperative care)
- Imposes new requirements when employers use a medical examination instead of UR, including a 90-day deadline and a similar same-licensure reviewer requirement
Mississippi reinstates topical cap
Earlier this month, the Mississippi Workers’ Compensation Commission formally adopted a correction to its medical fee schedule to reinstate a reimbursement cap on manufactured topical medications. This cap was inadvertently removed in the Commission’s earlier fee schedule updates that became effective June 1, 2026. No changes were made to the reinstated cap, which provides that the maximum reimbursement for manufactured topicals - other than patches - is the billed charge up to $30 for a 30-day supply, prorated for a lesser supply. MyMatrixx and other stakeholders recommended the Commission address this issue to avoid a potential loophole and increased costs.