Recent legislative and regulatory activities impacting workers' compensation pharmacy in CO, NY, OH, and TX
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.
Colorado proposed unification of workers’ comp treatment guidelines
The Colorado Division of Workers’ Compensation (DoWC) listened to stakeholder requests and announced an initiative to unify its Medical Treatment Guidelines (MTGs) into one, easier to use and understand exhibit. More information is available on the DoWC website including a survey to collect initial feedback by October 22, 2026. The DoWC anticipates the unified guidelines would take effect in September of 2027, with the estimated timeline as follows:
- Early preview in September 2026 provided a sample MTG section and survey
- A Task Force in January 2027 will collaborate with clinical specialists to refine draft
- An Advisory Panel in March 2027 will review the full draft and survey
- Rule-making/hearing to take place July 2027
- Anticipated effective date mid-September 2027
New York workers’ comp medical bill payment law proposed to be amended
New York Assembly 11714, a bill amending the state workers’ comp law, was introduced in September and was referred to the Assembly Labor Committee. This bill would, among other things:
- Acknowledge workers' comp insurance carriers and self-insured employers in the medical bill payment and liability provisions (already includes "employer")
- Add a process for providers or suppliers to file claims with the Workers' Compensation Board alleging a "pattern or practice" of non-payment by one of those payers
- Add increased potential penalties for payers
Ohio BWC proposed formulary updates
In early October, the Ohio Bureau of Workers’ Compensation (BWC) proposed updates to its drug formulary and first fill list. The proposed updates include coverage changes for some medications and the addition or removal of other medications. The BWC and its PBM use the formulary and first fill list for state fund claims; however, self-insuring employers (and their PBMs) may also use them if desired. The proposed changes were open for initial public comments through October 20, 2026.
Texas finalizes topical audit plan
The Texas Division of Workers’ compensation finalized its Topical Analgesic Plan-Based Audit in order to:
- Ensure topical analgesics are prescribed in accordance with the ODG and evidence-based medical practices
- Assess provider documentation supporting the medical necessity of any prescribing that deviates from established evidence-based guidelines
- Support appropriate therapeutic prescribing practices to promote optimal outcomes for injured workers
The DWC did seek stakeholder input on the previously proposed audit plan and MyMatrixx by Evernorth submitted recommendations for clarity on the selection criteria. The DWC incorporated our recommendations into the final Audit Plan. The DWC has indicated a goal to complete the audit in February 2027 and then post an executive summary.