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 workers’ comp pharmacy direction of care bill voted down
Arizona House Bill 2813 failed to pass a critical committee vote in February. This bill would have permitted employers or insurers to establish “formal pharmacy management networks” to provide medications for injured workers under contracted rates and enforce network use. The bill had opposition from police and fire associations, which was believed to hurt its chances of moving forward. A similar bill was introduced in 2025, which also failed to move. MyMatrixx by Evernorth shared recommended amendments to this year’s bill earlier in the process to add definitional clarity.
Louisiana bills could modify fee schedule process and replace treatment guidelines
Proposed bills in Louisiana could modify how workers’ compensation medical fee schedules are developed and updated and replace the state’s medical treatment guidelines.
House Bill 357 would amend medical fee schedule requirements by removing an existing reference to the charges being limited to the mean of usual and customary charges and replacing that with a new requirement that charges be “reasonable when compared to the workers' compensation reimbursement schedule and have similar characteristics of surrounding states.” The bill would also require:
- Any necessary fee schedule adjustments be made annually
- Quarterly reports from the Office of Workers' Compensation Administration to the legislative committees
Meanwhile, House Bill 819 would replace the current state-specific medical treatment guidelines with the Official Disability Guidelines (ODG) and provide guidance for treatment not covered by ODG.
Both bills were pre-filed in late February and provisionally referred to the House Labor and Industrial Relations Committee.
Mississippi proposed workers’ compensation medical fee schedule updates
The Mississippi Workers’ Compensation Commission proposed updates to its medical fee schedule for 2026. As outlined below, proposals include notable changes for pharmaceuticals further limiting physician dispensing, capping compounds and topicals, and decreasing base fee schedule rates. Other proposed amendments relate to the medical fee schedules, explanations of review (EORs), and payment timeframes.
Proposed pharmaceutical changes would:
- Reduce reimbursement rates for brand and generic drugs
- Limit physician dispensing to a single initial supply of no more than 10 days, reimbursed at no more than the lowest-cost generic equivalent
- Require prior authorization and medical documentation for compounds of amounts over $80
- Implement a three-tiered topical medication reimbursement methodology with:
- Levels up to a maximum of $80 per 30‑day supply
- A new topical patch cap allowing reimbursement up to $60 for a 30‑day supply (to replace existing $70 limit)
- Expand guidance on opioid use and limitations within pain management rule updates
Proposed bill review language changes include:
- Repricing agreements would need to explicitly state they apply to medical services for workers’ compensation claimants
- Clarification that an EOR would be required for each reconsideration, not just the initial bill
- Increase timelines from 30 days to 60 days for:
- Providers to submit a reconsideration request
- Payers to respond to a reconsideration request
- Providers to submit a dispute resolution
A hearing is scheduled for March 18, 2026. MyMatrixx is reviewing the proposed changes and intends to submit written comments.
West Virginia PBM bills progress
House Bill 5430 and Senate Bill 907 were introduced in the West Virginia Legislature in early February and propose changes that would impact pharmacy benefit managers (PBMs). The bills would:
- Prohibit the Public Employees Insurance Agency (PEIA) from contracting with a PBM that owns or has affiliated pharmacies licensed in the state.
- Prohibit PBMs from charging a private payer an amount greater than the national average drug acquisition cost (NADAC). If NADAC is not available, the PBM would not be able to charge an amount greater than the amount the PBM paid the pharmacy.
Under current law, a PBM is required to pay a pharmacy no less than NADAC plus a specific dispensing fee (a mandated reimbursement ‘floor’ regardless of agreed-to contracted rates, which tends to raise costs). The proposed restriction on what a PBM can charge may have unintended consequences on the overall pharmacy payments to comply with the amount charged to a payer by a PBM, including in workers’ comp claims.
Furthermore, these bills would require the Office of the Insurance Commissioner to conduct an ongoing study on the cost to dispense outpatient medications. HB 5430 passed the House and is pending in the Senate. SB 907 remains in the Senate Health and Human Resources committee.