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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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California P&T Committee to Address MTUS Updates and Ibuprofen Price Outliers

The April 15th hybrid meeting will take place from 12:30 PM to 2:30 PM PST, covering a wide variety of pharmacy topics.
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April 13, 2026

Louisiana Bill Would Remove Prescription Drugs from MTS Authorization and Appeals

Louisiana introduced a bill that would remove prescribed drugs from the Medical Treatment Schedule (MTS) authorization timelines and Medical Director appeal process under the workers’ compensation law.
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April 6, 2026

West Virginia PBM Bill Bans Spread Pricing

A new West Virginia PBM bill, effective immediately, prohibits spread pricing and requires PBM fees to be transparent and independent of drug cost.
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April 6, 2026

Wisconsin Agreed Bill Expands PTSD Eligibility

On March 31, Wisconsin passed a bill expanding PTSD‑only workers’ compensation claim eligibility for certain first responders and adopting a broader package of agreed‑upon reforms.
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April 6, 2026

WCRI Study Finds Provider Networks Improve Claim Outcomes

A new study from the Workers Compensation Research Institute found that injured workers treated in medical provider networks have lower medical and total claim costs, faster access to care, and improved disability outcomes.
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April 6, 2026

NCCI Highlights 2026 Legislative and Regulatory Trends

NCCI’s 2026 Emerging Legislative and Regulatory Issues report identifies heat exposure, workplace violence, and broader workers’ compensation system changes as key areas impacting workers’ compensation programs.
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April 6, 2026

Louisiana Bill Would Modify Key Parts of State’s Workers’ Compensation System

On March 31, Louisiana introduced a bill that would change how Medical Maximum Improvement (MMI) is defined and how wage-loss benefits are paid.
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April 6, 2026

Oklahoma Bills Would Create Conflicts for Workers’ Compensation Pharmacy

Two Oklahoma bills heading for House consideration would establish a NADAC based reimbursement floor, minimum dispensing fees, and a shortened 30 day payment timeframe.
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March 30, 2026

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
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 Further resources you may be interested in

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

States Consider Expanding Presumptions

So far in 2026, eight states and counting are seeking to expand existing presumptions or create new presumptions.
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Could AI-Designed Drugs Impact Regulatory Frameworks?

While AI can be effective in some elements of drug design, AI models currently struggle to explain their decision making, a key component of drug review.
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Preliminary Findings from the 2026 Workers’ Comp Industry Insights Survey Report

Risk & Insurance® magazine published high-level findings from the eighth annual survey, in collaboration with Healthesystems.
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Year in Review: What Made the Biggest Impacts in Workers’ Comp Claims Management in 2025?

From claims complexity to mental health, here’s what impacted workers’ comp claims management last year.
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New York Could Remove References to CDC Guidelines

After regional public health collaboratives formed in September, New York could be the first state to formally shift policies away from deferring to federal guidelines.
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On the Front Lines: How Does Climate Change Continue to Impact Workers?

What are the latest developments in climate change, and how does it continue to impact front-line workers such as ocean workers and construction workers?
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