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.
Arizona proposes workers’ compensation fee schedule updates
The Arizona Industrial Commission proposed annual updates to its fee schedules, intended to become effective May 1, 2026. While more changes are expected later this year for pharmaceuticals, the recent proposed changes include:
- A new statement that if more than one manufacturer produces a medication, whenever possible, pharmacies should seek to procure the medication with the lowest average wholesale price (AWP);
- A reimbursement cap increase for topical compounds (from $200 to $240); and
- The addition of over-the-counter medications to an area of the existing fee schedule that includes reimbursement conditions for physician dispensed medications or those dispensed by a pharmacy not accessible to the general public.
The proposed changes would also amend an existing provision that requires the payer to provide a copy of the valid contract to the provider “in the event of a dispute.” The proposed changes would update this condition to “if a dispute regarding the existence of a contract occurs” and would add a required 30-day timeframe to provide the copy.
The fee schedule updates also address other medical services, including a newly developed dental fee schedule.
The Commission will hold an interactive stakeholder meeting on February 12 and a public hearing on February 26. Written comments can also be submitted. More information can be obtained here.
The Commission held stakeholder meetings last year to discuss prescription topicals. MyMatrixx by Evernorth attended those meetings and 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 recommended fee schedule amendment language.
We do expect more proposed language updates to address topicals, and we look forward to continuing our productive engagement with the Commission on this important topic.
Hawaii workers’ compensation bills introduced in January hit three important topics: treatment guidelines, OTC medications and compounded medications
Hawaii Senate Bill 2292 would require the adoption of workers’ compensation medical treatment guidelines. The guidelines would be based on "principles of evidence-based medicine," incorporate the American College of Occupational and Environmental Medicine (ACOEM) Occupational Medicine Practice Guidelines, and specify treatments that do not require preauthorization. Outlined in the bill:
- Treatment guidelines would be considered presumptively correct on the issue of the extent and scope of any necessary treatment and “the standard” of care for all injured employees.
- Attending physicians would be required to follow a specified search sequence of the adopted guidelines and specific secondary guidelines to determine appropriate treatment for injured workers.
- There would be a prescribed process for an attending physician to challenge the guidelines’ presumption of correctness.
House Bill 1648 would amend the workers’ compensation law to add that no health care provider (defined in existing law as a practitioner such as a medical doctor, dentist, or APRN) shall prescribe or dispense an over-the-counter (OTC) drug. The stated reason for this amended language is the state's existing OTC drug reimbursement rates not being clearly provided and leading “some to charge inflated rates for these drugs, which drives up the cost of workers' compensation insurance policies.”
Additionally, Senate Bill 2751 and House Bill 2164 would add a new definition of "compounded prescription drug" into the workers’ compensation law. This would align the state law with federal standards for compounding by codifying the federal definition.
Michigan progresses on workers’ compensation physician dispensing reimbursement limit
The Michigan Workers’ Disability Compensation Agency (WDCA) shared draft physician dispensing reimbursement limitation language at its January 2026 Health Care Services Advisory Committee meeting. The draft language could limit workers’ comp reimbursement for physician dispensing to a set number of days from “inception” of first medical care. The WDCA’s intent is to not require reimbursement beyond the set number of days (42 days in the last draft) but still permit payers to reimburse beyond that if they choose. Rule changes to add that language may be formally proposed later this year.
The draft language resulted from a subcommittee that has been reviewing pharmaceutical cost concerns for over a year and recommended rule changes. The MyMatrixx Regulatory Affairs team was an active subcommittee member and provided input given concerns that persist with high-cost physician dispensed medications. We continue to stay engaged to offer recommendations to the state.
Montana workers’ compensation updates treatment guidelines
The Montana Department of Labor and Industry adopted updates to its medical treatment guidelines for services provided on or after January 10, 2026. The updated rules reference the Montana Utilization and Treatment Guidelines, 9th edition, 2025, which includes comprehensive updates to the Shoulder Injury guideline. All providers are required to use the adopted guidelines when providing treatment to an injured worker, and all insurers are to routinely and regularly review claims to ensure care is consistent with the guidelines. There is a rebuttable presumption that the adopted guidelines establish compensable treatment for primary and secondary medical services for the injured worker.
Nevada workers’ compensation pharmaceutical fee schedule increased
The Nevada Division of Industrial Relations, Workers’ Compensation Section posted an updated Medical Fee Schedule, effective February 1, 2026. The updates include a dispensing fee increase for pharmaceuticals to $13.70 (previously $13.31). Other medical rates were adjusted based on the annual change in the Consumer Price Index medical care component (published by the federal government).