Updates on recent legislative and regulatory activity impacting workers' compensation pharmacy
The MyMatrixx by Evernorth Regulatory Affairs team continually tracks and monitors legislation and regulation 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.
California workers' compensation provider contract dispute bill progresses
California Assembly Bill 1048 has passed out of the Assembly and committees in the Senate and is pending further potential final action in the Senate. This bill would expand the state's workers' comp provider payment dispute process - independent bill review (IBR) - to include a contract dispute involving any discount or reduction from the state fee schedule.
As part of the dispute process, the bill would require the IBR vendor to provide a written decision to the provider that includes the provider contract language used to uphold the decision. This is required for disputes involving a percentage discount or reduction and pharmaceutical reimbursements.
The American Association of Payers, Administrators and Networks (AAPAN) submitted a letter opposing this bill unless amendments are taken or the bill becomes a two-year bill to provide additional time to work through identified issues. MyMatrixx by Evernorth is a member of AAPAN.
Minnesota workers' compensation PTSD study released
The Minnesota Department of Labor and Industry (DLI) recently released a report on the state's post-traumatic stress disorder (PTSD) workers' compensation claims. The report, required by a 2023 law, was completed in partnership between the DLI and the University of Minnesota's Midwest Center for Occupational Health and Safety. The report includes several recommendations to provide workers with a more positive experience and process for:
- Diagnosing PTSD
- Filing a work-related PTSD claim
- Receiving effective treatment
- Returning to work
Oklahoma invites comments on workers' compensation medical fee schedule
The Oklahoma Workers' Compensation Commission (WCC) has invited written comments and feedback from stakeholders on its current Medical Fee Schedule. They will use the comments to assist in the development of the next fee schedule update, scheduled for 2026.
Comments should be submitted to okfeedback@fairhealth.org no later than September 7, 2025. Additional comment opportunities will be announced once a 2026 fee schedule draft is released.
The WCC is required to review and submit an updated Medical Fee Schedule to the state legislature for approval every two years. The Medical Fee Schedule includes billing and reimbursement provisions for pharmaceuticals, among other medical services.
Pennsylvania workers' compensation bill would require medical marijuana reimbursement
On the stated premise that injured workers with chronic pain need a "workable option for pain management other than opioids," Pennsylvania House Bill 1766, was introduced in early August. The bill would amend the state's workers' compensation law to require an employer to reimburse a qualifying patient for certified medical use of marijuana under the state's "Medical Marijuana Act."
HB 1766 would:
- Entitle the injured worker to a dollar-for-dollar reimbursement of the medical marijuana, up to a maximum monthly reimbursement of $250 and a yearly maximum of $3,000.
- Require workers' compensation insurers to reimburse injured workers on at least a quarterly basis
- Provide the injured worker reimbursement for the fees to obtain or renew their medical marijuana identification card (currently $50 per year).
HB 1766 was referred to the House Labor and Industry Committee, where it is pending further action. A similar House bill was introduced in 2023 and failed to have any movement beyond being referred to that same first committee.