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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Advocacy Opportunity Cost Containment

Alaska Begins Review of 2027 Fee Schedule

Targets for consideration include pharmacy rules, physical therapy, DME, and ancillary services.

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June 8, 2026

Pharmacy Data

CWCI: Migraine Drugs Now Third Highest in Spend in California

While migraine drugs make up less than 1% of prescriptions, they now make up 7.5% of drug spend, primarily driven by CGRP drugs.

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June 8, 2026

Presumptions

Connecticut Creates Task Force for First Responder Claim Delays

The task force must submit a report of findings and recommendations by January 1, 2027.

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June 8, 2026

Presumptions

Florida Expands Cancer Death Benefits for Firefighters

Florida Senate Bill 984 goes into effect July 1, 2026.

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June 8, 2026

Presumptions

South Carolina to Cover Stroke for Firefighters

The bill also expands presumption eligibility to cover conditions that arise during training, rescue activity, or within 24 hours of strenuous duty.

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June 8, 2026

Cost Containment Treatment Guidelines

Wisconsin Shares Updates on Medical Treatment Guidelines and Hospital Fee Schedule

While progress continues, the guideline updates are delayed due to quorum issues, and the hospital fee schedule is still in early planning stages.

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June 1, 2026

Claim Costs Claim Data Industry Data

WCRI Publishes 2026 Medical Price Index

The report compares prices paid for medical services across 36 states from 2008 to 2025.

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June 1, 2026

Claim Data Pharmacy Data

California Publishes Independent Medical Review Report

Pharmaceutical requests represented 30.6% of all treatment requests submitted for IMR, a modest decline from 32.7% in 2024.

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May 25, 2026

Mental Health Psychedelics

Georgia Enacts Regulations for Psychedelic Clinics

The Georgia Composite Medical Board will issue rules and regulations for clinics administering psychedelic-assisted therapies by December 31, 2026.

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May 25, 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 Seek to Limit AI-Generated Care Decisions, Despite White House Order

Legislators continue to introduce bills to limit AI-generated healthcare decisions, even as the U.S. Attorney General has been instructed to oppose them.

White House Issues Executive Order to Reschedule Marijuana

Rescheduling marijuana to Schedule III will allow for greater clinical research, possible FDA-approved drugs, and more.

States Consider Expanding Presumptions

So far in 2026, eight states and counting are seeking to expand existing presumptions or create new presumptions.

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.