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.
New York workers’ comp anti-pharmacy network bills reintroduced
Workers’ comp pharmacy network bills, S 9331 and A 10413, were introduced in New York in early March. The bills would allow use of out-of-network pharmacies under several conditions such as dispensing delays, missed authorization deadlines, or emergencies, in addition to other circumstances as defined by Workers’ Compensation Board (WCB) regulations.
Both bills are similar to bills that have passed but were then vetoed by New York Governor Kathy Hochul over the last two years. In a previous veto message, Hochul noted the bills would increase litigation, add bureaucratic steps for the WCB, and result in further delays in obtaining needed medication. In response, in 2025, the WCB amended its regulations to provide a process for out-of-network pharmacy use in situations when there is a non-established body part or condition. Hochul referenced those adopted regulation changes in her last veto message.
Pennsylvania workers’ comp compound and topical cap legislation introduced
Pennsylvania Senate Bill 1215 was introduced on March 13 and subsequently referred to the Senate Labor & Industry Committee. The bill addresses “excessive costs” for topical and compounded medications in the state’s workers’ comp system. The bill:
- Would require compound billing and reimbursement based on the ingredients.
- Would add caps on compounds and topicals based on certain dollar amounts (like other states have adopted).
- Would incorporate the Federal Upper Limit (FUL) as part of a “lesser of” reimbursement methodology in capping non-compound topical drugs.
- Would, as currently written, not remove the existing fee schedule law’s reference to average wholesale price (AWP), which has been the source of notable litigation that is still pending with the state’s Supreme Court.
A sponsor memo published in late February previewed this legislation, and an earlier version of the bill language was shared with MyMatrixx by Evernorth for our feedback. This bill incorporates input from MyMatrixx and other stakeholders over the last year to legislative staff.
Washington workers’ comp formulary updated
The Washington State Department of Labor & Industries (L&I) announced changes to its outpatient drug formulary, effective April 1, 2026, to address Fluticasone furoate/vilanterol and Budesonide/glycopyrrolate/formoterol (Breztri Aerosphere). The formulary is a list of therapeutic classes and drugs covered under L&I's prescription drug program. 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.
FDA to update NDC format
The U.S. Food and Drug Administration (FDA) published a final adopted rule to update the formatting for national drug codes (NDCs) starting in 2033. NDCs are an industry standard (governed by the FDA) for uniquely identifying drug products, and they are used throughout the drug supply chain, including drug pricing compendia and pharmacy billing transactions.
Current NDC formatting: 10-digit, three-segment numbers that may appear in several configurations.
Newly adopted NDC formatting: 12 digits with three distinct segments and one uniform configuration.
The FDA will begin assigning NDCs in the new uniform, 12-digit format on the rule’s effective date of March 7, 2033. Existing 10-digit NDCs will be required to convert to the new uniform format.
The rule does permit a three-year transition period following the effective date during which firms that use existing 10-digit NDCs on drug product labeling should begin updating the 10-digit format with the new 12-digit format. Firms should update to the new 12-digit format by adding leading zeros to the labeler code, product code, and/or package code segments of the current 10-digit format as soon as possible. During the three-year transition period, the FDA requires parties to ensure their systems can handle both the 10-digit and 12-digit formats. This rule was originally formally proposed in 2022.