Updates on recent legislative and regulatory activity impacting workers' compensation pharmacy
The MyMatrixx by Evernorth Regulatory Affairs team continually tracks and monitors legislation and regulations impacting workers’ compensation pharmacy. Below are some updates on more recent developments. You can follow many of these measures and more with our online tracker.
Alabama workers’ compensation fee schedules updated
The Alabama Workers’ Compensation Division (WCD) recently adopted annual updates to its fee schedules. While effective March 1, 2026, the updates were not posted on the WCD website until over a month later, thus the updates were retroactive to that date.
Relevant for pharmaceuticals, the updates include the following increases to pharmacy dispensing fees:
- Brand medication dispensing fee increased to $11.71 (previously $11.44)
- Generic medication dispensing fee increased to $15.22 (previously $14.86)
Reimbursement rates for various administered medications, as well as other medical services were also updated.
Arizona workers’ compensation fee schedules updated
The Arizona Industrial Commission approved updates to its Physicians' and Pharmaceutical Fee Schedule, to be effective May 1, 2026.
Updates specific to pharmaceuticals included:
- The reimbursement cap for topical compound medications increased from $200 to $240 for a 30-day supply.
- Over-the-counter medications were added to an existing section of the fee schedule setting several coverage conditions for medications dispensed by a “healthcare provider” or in a “pharmacy not accessible to the general public.”
- A statement was added to emphasize that, whenever possible, pharmacies should seek to procure a medication with the lowest average wholesale price (AWP) when a medication is produced by more than one drug manufacturer.
The approved updates also amended the provision that required a payer to provide a copy of the valid contract to the provider “in the event of a dispute” to state instead “if a dispute regarding the existence of a contract occurs.” This update also includes a required 30-day timeframe to provide that contract copy. The updates also address other medical services, including a newly developed dental fee schedule.
The MyMatrixx by Evernorth Regulatory Affairs team participated in this rulemaking by submitting written comments to the Commission and attending stakeholder meetings. We also met individually with the Commission to share our experience with higher cost topicals. We encouraged the Commission to look at the approaches of other states to help tackle the issue and recommend fee schedule amendment language. We expect more language updates to address prescription topicals to be proposed later, and we look forward to continuing our productive engagement with the Commission on this important topic.
Louisiana bills propose sweeping changes to workers’ comp medical billing, fees, and authorization
Three bills have been introduced in Louisiana in 2026 that propose to make substantial revisions to the state workers’ compensation law, Louisiana Senate Bill 408, introduced March 17 and then referred to the Senate Committee on Labor and Industrial Relations, would revise the medical fee schedule to be based on:
- the 75th percentile of the Practice Management Information Corporation Medical Fees Directory for professional services
- the 75th percentile of a newly created “All Workers' Compensation Medical Claims Database” for facility services
That latter database would contain medical and pharmacy claims information submitted by payers providing workers' compensation coverage in the state, effectively creating a new medical state reporting system with data submitted quarterly.
SB 408 would also:
- Prohibit reimbursement "by report"
- Amend the dispute process related to medical fees
- Mandate electronic medical billing
- Permit the creation of a state-wide electronic prior authorization portal for purposes of approving medical care in the workers’ comp system
- Require implementation of a “Workers' Compensation Medical Quality and Outcomes Program” to “measure, evaluate, and improve the quality and effectiveness of medical care provided to injured employees”
Louisiana House Bill 1047 was introduced March 30 and was referred to the House Committee on Labor and Industrial Relations. The bill proposes to amend an existing provision to exclude requests for authorization for prescription drugs in workers' comp cases. It may be seeking to codify that prescription drugs do not require prior authorization.
Louisiana House Bill 357, filed in February, passed the House and advanced to the Senate in early April. This bill would amend requirements related to the medical fee schedule to remove referencing charges limited to the mean of the usual and customary charges and replace with a requirement to be reasonable when compared to the workers' comp reimbursement schedule and have similar characteristics of surrounding states. The first related fee schedule under this new method would be required to take effect on January 1, 2027. HB 357 would require annual adjustments to the fee schedule supported by collected data and information. The Office of Workers' Compensation Administration would be required to report quarterly on the process to legislative committees.
Washington workers’ comp bill amends treatment guidelines and provider choice provisions
Washington Senate Bill 5847, signed into law on March 24, amends the state’s workers’ compensation law in several areas related to treatment guidelines and provider choice.
Effective June 11, 2026, the bill gives providers greater clinical discretion by stating that they must follow the Department of Labor and Industries’ evidence-based coverage decisions and treatment guidelines when medically necessary, and applicable national guidelines when medically appropriate for all claims regardless of date of injury. This replaces prior “required to follow” language.
Effective for treatment decisions on or after January 1, 2028, the law also expands worker choice and tightens utilization review (UR) timelines as follows:
- Employers must inform workers of their rights to choose providers and may not coerce treatment decisions, with penalties for violations.
- Workers may obtain non-network care if no network provider is available within 25 miles, subject to notice and provider search requirements, and may begin treatment immediately.
- UR decisions must be issued within 10 business days or are automatically authorized (causation disputes require a department order within 30 days; continued treatment requests have a 120-day submission deadline).
The law also expressly allows ongoing treatment for accepted cancer diagnoses and clarifies claim reopening rights.
MyMatrixx to attend the IAIABC Forum
The International Association of Industrial Accident Boards and Commissions ( IAIABC) will hold its annual “ Forum” April 20 – 22 in Greenville, South Carolina. The IAIABC is an organization of workers' compensation jurisdictional agencies (66 jurisdictions in the U.S. and internationally), as well as associate or electronic data interchange members from the industry – including MyMatrixx. The event includes educational sessions and committee meetings to discuss workers' compensation regulation and administration. MyMatrixx is active in various IAIABC committees and is also a sponsor of this year’s Forum.