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.
Florida DWC proposes to remove physician dispensing rules
Following an appeals court decision, the Florida Division of Workers’ Compensation (DWC) has proposed changes to remove invalidated provisions from Rule 69L-7.730 (Health Care Provider Medical Billing and Reporting Responsibilities) and to 69L-7.740 (Insurer Authorization and Medical Bill Review Responsibilities). This would remove the language regarding required reimbursement for medications dispensed by physicians and other medical practitioners. A hearing is scheduled for July 15, 2026. MyMatrixx by Evernorth will be following this process closely.
For context: Earlier this year, an appellate court held that the Florida’s 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 these rule provisions adopted by the DWC that extended that choice to dispensing practitioners, finding they unlawfully expanded the statute and constituted an invalid exercise of delegated legislative authority. More details on the court ruling were discussed in this prior blog post
Louisiana workers’ comp reform bill signed
On June 3, 2026, Louisiana Senate Bill 408 was signed into law, significantly amending the state workers’ compensation law for various medical and claims processing topics. The new law requires the Office of Workers’ Compensation Administration (OWCA) to take several actions before many of the provisions can be implemented. Notable provisions include:
- Update medical fee schedules (rulemaking to start no later than July 1, 2029)
- Implement a new medical database with required reporting of medical and pharmacy data by workers’ comp payers beginning January 1, 2027
- Mandate electronic billing for providers (effective July 1, 2027)
- Create and add modified bill payment timeframe and dispute language (various effective dates)
- Launch a “Workers' Compensation Medical Quality and Outcomes Program” to measure, evaluate, and improve the quality and effectiveness of medical care provided to injured workers (required no later than January 1, 2031)
- Potentially implement a statewide electronic prior authorization portal (no mandated implementation timeline)
Significant guidance and formal rules from OWCA on various provisions are expected and will be needed. The extended window for implementation of the above opens the possibility that future legislative sessions could amend some of the provisions. MyMatrixx will be following future actions on these topics, and our trade association has planned discussions with OWCA as it proceeds with implementation efforts.
Also in Louisiana, House Bill 819 passed its first chamber but ultimately failed. The bill would have incorporated the Official Disability Guidelines into the state’s medical treatment guidelines. However, looking forward, SB 408’s future “Workers' Compensation Medical Quality and Outcomes Program” may include utilization of evidence-based treatment guidelines
Anti-pharmacy network legislation fails while budget legislation succeeds for New York workers’ comp.
Two re-introduced workers’ comp anti-pharmacy network bills in New York (S 9331 and A 10413), which would have allowed use of out-of-network pharmacies under additional conditions, have failed upon legislature adjournment.
Both bills were similar – yet modified – from others that have passed over the last two years but were then vetoed by New York Governor Kathy Hochul. Once again, MyMatrixx worked through our trade association to voice opposition to the bills. We expect to see similar legislation in future legislative sessions.
Also in New York, recently passed and signed budget legislation makes several changes to the workers’ compensation law, including:
- Permitting any licensed provider (acupuncturist, chiropractor, nurse practitioner, occupational therapist, physical therapist, physician, physician assistant, podiatrist, psychologist, or social worker) to treat injured workers, unless found on an exclusion list published and maintained by the Workers’ Compensation Board (WCB), effective January 1, 2028 (current law, until then, requires specific authorization by the WCB)
- Funding for workers’ compensation fraud units within New York state district attorneys’ offices
- Increasing the threshold for pre-authorization for certain specified medical services to $1,500 (previously $1,000), effective January 1, 2028
In promoting the ‘universal’ provider authorization, Governor Hochul’s office noted that only about 10% of eligible providers have gone through the existing WCB authorization process, “forcing injured workers to wait for appointments or travel long distances to receive care.” The governor’s office also supported anti-fraud funding to “ensure they have the necessary resources to investigate and prosecute these crimes, ultimately protecting honest workers and helping to reduce costs for businesses across New York State."
Washington workers’ comp formulary updates
The Washington State Department of Labor & Industries (L&I) announced the addition of four new drug classes to its outpatient drug formulary, effective July 1, 2026. However, the additions either require prior authorization or are in denied status.
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.