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.

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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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Presumptions

Arizona Could Cover Travel Injuries for Firefighters

Injuries occurring when traveling to and from work would be covered, assuming no criminal activity was undertaken.

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February 2, 2026

Mental Health Presumptions

Florida and Vermont Could Extend PTSD Coverage to 911 Dispatchers

Pre-existing PTSD presumptions for first responders could be extended to 911 dispatchers.

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February 2, 2026

Presumptions

Maryland and Arizona Target Hypertension Presumptions for Firefighters

Maryland would create a hypertension presumption, while Arizona would strengthen theirs by increasing rebuttal requirements.

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February 2, 2026

Presumptions

Vermont and Virginia Consider Covering Additional Cancers for Firefighters

Vermont could soon cover larynx, pharynx, and trachea cancers, while Virginia could cover lung cancer and non-Hodgkin’s lymphoma.

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February 2, 2026

Presumptions

Virginia Proposes Spousal Wage Reimbursement for At-Home Caretaking

The bill applies to the spouse of law-enforcement officers who require at-home care following a line-of-duty injury.

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February 2, 2026

Access to Care Technology

Utah AI Prescription Renewal Pilot: Updates

The pilot can approve a limited set of 192 medications for chronic conditions and will be broken into three stages, the first including 250 patients.

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January 26, 2026

Billing & Payments Claims Procedures

Arizona Could Allow Payers to Direct Injured Workers to Pharmacy Networks

Employees could be informed of network pharmacies, while out-of-network pharmacies could be denied reimbursement.

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January 26, 2026

Billing & Payments Claims Procedures

Oklahoma Proposes Contested PBM Bills

One bill conflicts with existing statutes on the timeline to pay pharmacy bills, while another could be preempted by TRICARE law.

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January 26, 2026

Advocacy Opportunity Pharmacy Data Treatment Guidelines

California P&T Committee Outlines Pharmacy Topics for Review

The meeting discussed proton pump inhibitors and the need to review utilization, and future meetings will address GLP-1 drugs, migraine drugs, and more.

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January 26, 2026

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Further resources you may be interested in

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

Expert Q&A: Cybersecurity Tactics in Workers’ Compensation

RxInformer editors sat down with Healthesystems’ AVP of Information Security and resident cybersecurity expert, Tony Brown, to discuss how cyber threats affect workers’ comp organizations.

Drug Pricing Legislation and Its Impact on Workers' Comp

Lawmakers look to regulate the U.S. drug supply chain in ways that could impact workers’ comp pharmacy management.

High Prices, High Impact: Meet the Drugs Driving Up Claim Costs in Workers’ Comp

High-impact drugs, including topicals and compounds, represent proportionately low utilization compared to opioids or NSAIDs, but they can increase pharmacy spend exponentially on impacted claims.