Recent legislative and regulatory activities impacting workers' compensation pharmacy in AK, CA, FL, and WA
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 Board approves recommended fee schedule changes
In a late August meeting between the Alaska Workers' Compensation Board and the Workers' Compensation Medical Services Review Committee, the Board approved the Committee’s recommendations for updates to the Alaska Workers’ Compensation Medical Fee Schedule with some additional technical edits. A resulting updated fee schedule and related regulation have been formally proposed with a hearing scheduled for October 15, 2026, and written comments are due October 9, 2026.
The proposed updates include amendments to the language governing reimbursement for pharmaceuticals, including:
- Language addressing reimbursement for over-the-counter medications
- Clarification regarding billing and reimbursement of physician dispensed and repackaged medications
- New reimbursement caps for compounded and non-compounded topical medications
- New compounding fees dependent on the number of ingredients in the compound
- Language tying reimbursement to the lowest generic equivalent available for a medication
The MyMatrixx by Evernorth Regulatory Affairs team assisted the committee providing clarifying language and insight on provisions adopted in other states to address topical and compounded medication costs. Any adopted changes would take effect January 1, 2027.
California MPN contract disclosure bill dies
California Assembly Bill 1048 has failed to pass this year. As last amended, the bill would have required a payer’s explanation of review (EOR) or explanation of benefits (EOB) to include the state-assigned MPN identification number and an email address that the rendering medical provider may use to request a copy of the underlying contract that entitles them to the preferred rate (mere disclosure of an MPN would not satisfy this requirement).
The bill would have also required the payer, upon request, to provide the rendering provider or their agent with a copy of the underlying contract once per 365-day period.
AAPAN, a trade association in which MyMatrixx maintains membership, had voiced opposition to this bill. A fiscal impact note associated with the bill noted that the Department of Industrial Relations indicated it would incur cost of over $3 million annually to implement the provisions of the bill, and that the bill would result in increased costs to the State as direct employer, though the magnitude was unknown but could reach the tens of millions of dollars annually.
Florida practitioner dispensing rules repealed and state reporting rules updated
As expected, the Florida Division of Workers’ Compensation (DWC) officially repealed rules related to practitioner dispensing that were invalidated by an appellate court. Two paragraphs from Rule 69L-7.730 (Health Care Provider Medical Billing and Reporting Responsibilities) and Rule 69L-7.740 (Insurer Authorization and Medical Bill Review Responsibilities) were repealed, effective September 2, 2026 (the legal validity of those provisions was already invalidated by the earlier court decision).
For context: Earlier this year, the First District Court of Appeal in Florida held that the Florida workers’ compensation statute’s injured worker “free, full, and absolute choice” provision applies only to licensed pharmacies/pharmacists and does not include physicians or other “dispensing practitioners.” Given that, the court invalidated the previously adopted rule provisions that extended that choice to dispensing practitioners, finding they unlawfully expanded the statute and constituted an invalid exercise of delegated legislative authority.
In addition, the Florida DWC adopted updates to its medical state reporting rules, effective September 2, 2026. Those updates were to move reference to the existing Medical EDI Implementation Guide (MEIG) into the larger state reporting rule and to remove outdated testing timeframe language. More information on these updates can be viewed here.
Washington workers’ comp formulary updated
The Washington State Department of Labor & Industries (L&I) announced the addition of two new drug classes to its outpatient drug formulary, effective October 1, 2026. The new drug classes are Aldosterone Synthase Inhibitor and Hepatitis D Treatment Agents, both of which require prior authorization.
The drug formulary is a list of therapeutic classes and drugs that are covered under L&I's drug benefit. Drugs listed on the formulary do not guarantee coverage and may be subject to specific L&I policy and determination of appropriateness for the accepted conditions. Although Washington is a “monopolistic state,” it permits employers to self-insure their own workers’ compensation claims. Self-insuring employers are generally required to authorize treatment in accordance with L&I rules.