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A significant part of the Healthesystems vision is to create a more integrated experience for our customers

Advocacy & Compliance

Healthesystems’ Advocacy & Compliance experts are essential in the management of pharmacy and ancillary benefits for our clients. By tracking and influencing regulatory activity, our team stays  ahead of evolving trends and identifies opportunities to advocate on behalf of our clients, their injured workers, and the broader industry.

The Advocacy & 
Compliance Team

Monitors and reports on proposed and pending regulatory changes that impact workers' comp, helping shape effective program strategies

Advocates for fair and balanced public policy through proactive engagement with regulators, customers, and other stakeholders throughout the rulemaking lifecycle

Supports operational compliance by providing guidance to internal stakeholders and external partners during the implementation of new regulatory changes

Regulatory Recap

A weekly e-newsletter informed by the Advocacy & Compliance team to help keep our clients and industry contacts in the know on the latest legislation and policy updates impacting workers’ comp.
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DME Vendors Are Not “Providers” Under Pennsylvania Workers’ Comp Law

A Pennsylvania appellate court ruled that a distributor of Durable Medical Equipment (DME) does not qualify as a “healthcare provider” under the Workers’ Compensation Act and therefore cannot use the state’s medical fee review process to dispute reimbursement.
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March 30, 2026

New York Proposes Regulations Expanding Pay Without Prejudice Rules for Medical Payments

The New York Workers’ Compensation Board has proposed rules allowing carriers to temporarily pay for medical treatment while compensability is under review, without admitting liability.
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March 30, 2026

Colorado Will Host Fee Schedule Listening Session

The Colorado Division of Workers’ Compensation (DOWC) will host a listening session on April 9, 2026 at 4:00 p.m. MT to gather feedback from employers, insurers, providers, and other workers’ compensation stakeholders on Rule 18 (Medical Fee Schedule).
Read More →
March 30, 2026

Arizona Publishes 2026 Medical Fee Schedule

The updated schedule increases the maximum reimbursement for topical compounds and urges pharmacies to select the lowest-AWP medication when available, among other changes.
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March 30, 2026

Idaho Bill Would Expand the Definition of “First Responder” for PTSD Coverage

The new bill would add coroners, “medicolegal” death investigators, and qualifying coroner employees to the list of first responders eligible for workers’ compensation benefits for post-traumatic stress injuries.
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March 30, 2026

Pennsylvania Proposes Price Caps on Compound and Topical Drugs

Senate Bill 1215 proposes a $400, 30-day supply cap for compound drugs and a $240, 30-day supply cap for non-compound topicals.
Read More →
March 23, 2026

Florida Appeals Court Rules in Favor of Carriers and Employers on Physician-Dispensed Drugs

While injured workers have an absolute choice over their pharmacist, physicians are not considered pharmacists and therefore not entitled to reimbursement.
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March 2, 2026

Hawaii May Require Compounds to Be Created by Licensed, In-State Pharmacists

The state’s definition of “compounded prescription drug” would be updated to fall in line with federal standards.
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March 23, 2026

New Jersey Proposes Medical Marijuana Reimbursements in Workers’ Comp

Two new companion bills carryover similar marijuana reimbursement proposals from 2024.
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March 23, 2026
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 Further resources you may be interested in

Additional articles and updates from Healthesystems related to policy shaping workers’ comp.

FDA Orders Opioid Manufacturers to Update Prescribing Information for Long-Term Use

All opioid manufacturers must update their drug labeling to align with a list of notes provided by the FDA.
Read More

Burden of Proof: Unpacking Presumptions in Workers’ Comp

Exploring the expansion of presumptions in PTSD, cancers, and more.
Read More

FDA Takes Steps to Restrict Certain Kratom Products

The FDA recommended concentrated 7-OH kratom products to be rescheduled under the Controlled Substances Act.
Read More

The Emerging Role of AI in Workers’ Comp – and the Regulations Surrounding It

An expert Q&A with Sandy Shtab, VP of Industry and State Affairs, on AI in workers’ comp and the regulations surrounding it.
Read More

Nevada Enacts Workers’ Comp Formulary

The state will adopt the ODG Drug Formulary by July 1, 2027, with coverage of non-formulary drugs allowed through January 1, 2028.
Read More

CWCI Publishes Report on Long-COVID

Long COVID cases made up 4.7% of COVID claims, totaling 6,000 claims, yet their medical payments totaled $105 million.
Read More
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