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 continues to tackle topicals
The Arizona Industrial Commission is continuing its review and dialogue with stakeholders on potential fee schedule changes related to prescription topical medications. The latest draft language, recently distributed by the Industrial Commission’s Medical Resource Office (MRO), would:
- Cap reimbursement for prescription topical medications at $300 for a 30-day supply, pro-rated based on the number of days’ supply dispensed, plus a $7 dispensing fee.
- Require a pharmacy to provide documentation to the payer to justify charges for a prescription topical medication with an actual acquisition cost exceeding that cap and then limit reimbursement for that medication to 130% of the actual acquisition cost plus a $7 dispensing fee.
Plus, if a pharmacy encounters this situation for more than one consecutive month, before dispensing the medication a second time, the pharmacy would be required to provide documentation to the payer demonstrating the inability to procure an equivalent medication at a lower average wholesale price (AWP) and establish payment terms. The terms should not result in a reimbursement to the pharmacy that is less than the actual cost.
MyMatrixx has attended the MRO’s stakeholder meetings on this topic and reviewed the draft language. Along with recommending fee schedule amendment language, we encouraged the Commission to look at the approaches of other states in dealing with topical medications. MyMatrixx looks forward to continuing productive engagement with the Commission on this important topic.
California updates workers’ comp. chronic pain and eye disorders treatment guidelines
The California Division of Workers’ Compensation (DWC) adopted updates to its Medical Treatment Utilization Schedule (MTUS) treatment guidelines, effective for services rendered on or after June 1, 2026. The updates incorporate the following updated American College of Occupational and Environmental Medicine (ACOEM) guidelines:
- General Approaches – Initial Approaches to Treatment Guideline (ACOEM December 22, 2025)
- Eye Disorders Guideline (ACOEM December 22, 2025)
- Chronic Pain Guidelines (ACOEM December 22, 2025)
In a separate action, the DWC proposed additional MTUS changes to incorporate the following ACOEM guideline updates:
- Ankle and Foot Disorders Guideline (ACOEM January 29, 2026)
- Hip and Groin Disorders Guideline (ACOEM January 29, 2026)
A virtual public hearing on the ankle and foot and hip and groin updates is scheduled for June 5, 2026, with written comments also due that day.
Maryland workers’ comp presumption bills signed into law
Three Maryland workers’ compensation bills adjusting presumptive coverage for certain first responders were signed in late April.
House Bill 347 amends the law to add an occupational disease presumption for hypertension in certain first responders.
House Bill 878 and Senate Bill 449 extend an existing workers' comp presumption for heart disease and hypertension to include, subject to certain conditions, Carroll County correctional deputies who suffer from heart disease or hypertension resulting in partial disability or death.
Presumptive coverage in workers’ compensation for certain conditions in first responders continues to trend this year in state legislatures. For more on this topic, view our recent continuing education webinar presentation.
South Carolina workers’ comp amended laws expand firefighter presumption and modify fee schedule development
South Carolina House Bill 3163, signed into law and effective on May 15, 2026, adds stroke to the list of firefighter impairments/injuries presumed to have arisen out of and in the course of employment in a workers' compensation claim. Heart and respiratory disease were already included in that area of law.
In addition, House Bill 3874, signed into law on May 18, 2026, modifies the way in which the South Carolina Workers’ Compensation Commission (WCC) reviews and updates its medical fee schedule. The bill requires the WCC to review the fee schedule annually in consultation with a nine-member, stakeholder-representative “Cost Containment Committee” and hold a public hearing to receive comments from stakeholders. The annual review must consider the medical consumer price index and the workers' compensation fee schedules of other states in the region. The bill also removes an existing requirement that the WCC conduct an evidentiary hearing to review a proposed adjustment to increase or reduce fees by more than ten percent annually.