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.
California updates workers’ comp. mental health 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 April 1, 2026. These updates incorporate the following updated American College of Occupational and Environmental Medicine (ACOEM) guidelines:
- The Introduction to the Workplace Mental Health Guideline (ACOEM October 1, 2025)
- Post-traumatic Stress Disorder and Acute Stress Disorder (ACOEM October 1, 2025)
Adopted MTUS guidelines are presumed to be correct on the issue of extent and scope of medical treatment, and they are intended to guide provision and authorization of treatment in the state’s workers’ comp system.
California workers’ comp. P&T Committee recommends removing high-cost Ibuprofen strength
The California DWC Pharmacy & Therapeutics (P&T) Committee held its quarterly public meeting April 15, 2026.
The committee summarized recent adopted changes (version 14) to the DWC’s MTUS drug list and reviewed the following specific drugs and drug categories for potential action:
- Reaffirmed the “non‑exempt” status of pregabalin and gabapentin but debated whether the existing four‑day peri‑operative supply allowance was sufficient. A motion was passed recommending a longer 14-day peri‑operative allowance for both drugs.
- Agreed to differentiate the product formulations of cyclobenzaprine and tizanidine. A motion passed to allow tizanidine tablets and solution as special fill for four days, while capsules would remain non‑exempt.
- Recommended the availability of Duloxetine remain “exempt,” characterizing the issue as supply‑chain related rather than clinical.
- Discussed reviewing biosimilars, GLP drugs, proton pump inhibitors beyond 90 days, and anticonvulsant and migraine therapies in the future.
- Recommended removing ibuprofen 300 mg from the formulary due to concerns of its high price as compared to other strengths.
MyMatrixx by Evernorth posted about the novel 300 mg strength of ibuprofen and its high cost last year. We recommended to the DWC that the P&T Committee should discuss it and potentially take action.
Please note that P&T Committee recommendations would still need to be adopted by the DWC in a future version of the formulary. For context: “Non-exempt” and unlisted drugs generally require authorization through prospective review under the DWC’s formulary regulations.
Oklahoma governor vetoes conflicting and costly PBM bill
Oklahoma Senate Bill 2074 was vetoed by Governor Kevin Stitt on April 22. The bill would have mandated a minimum reimbursement to pharmacies that included a dispensing fee that was over twice the existing workers’ compensation law’s maximum dispensing fee.
The Oklahoma Health Care Authority estimated the bill would increase costs for the state’s Employees Group Insurance Division (administers group health insurance for employees of state agencies, school districts and other governmental units) an additional $11.6 million just in fiscal year 2027.
In his veto message, Stitt called the bill “a hidden tax, one that will ultimately be passed on to Oklahoma families, employers, and small businesses through higher premiums and increased healthcare costs.”
MyMatrixx voiced support for a veto through our trade association and corporate government affairs team, and we encouraged clients to voice concerns with the bill to the governor. A veto override from the legislature is still possible before the end of this year’s legislative session.
Texas to audit topicals in workers’ compensation
In its finalized 2026 Annual Audit Plan, the Texas Division of Workers’ Compensation (DWC) will review and evaluate:
- The appropriateness and medical necessity for prescribing topical analgesics.
- If time permits, peer review reports issued by utilization review agents to ensure they adhere to the Official Disability Guidelines and medically accepted standards of care and the appropriate selection of reviewing health care providers.
The DWC previously requested stakeholder input for audit topics for the 2026 Medical Quality Review Annual Audit Plan. MyMatrixx, along with our trade association (AAPAN), submitted comments supporting the selection of topical analgesics to be evaluated. MyMatrixx also provided the DWC with insight on how other jurisdictions have tackled the increased utilization and costs of topical medications in workers’ compensation.