Regulatory Tag: Advocacy Opportunity

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

At a March 11th meeting, the Workers’ Compensation Advisory Council announced a draft expected in fall of 2026 for public comments.

Interested stakeholders can submit comments on the proposal until April 28th.

The meeting covered potential updates to treatment guidelines, specifically for physical therapy, as well as other topics.

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

Healthesystems played a significant role in reshaping policy surrounding reimbursement for physician dispensing.

After public feedback is received at the February 19th meeting, the fee schedule is expected to take effect March 15, 2026.

The report includes recommendations for providers, and the findings could impact rules around prescribing, utilization review, and service delivery.

After expanding access to care by allowing these providers to treat injured workers, billing guidelines for these providers are being developed.

Under the proposal, the BWC would cover purchases through their surplus fund if the need stems from an allowed injury or occupational disease.

Stakeholder input could determine if the audit focuses on either topical analgesics or utilization review compliance.

This workshop will cover rules around panel provider lists, delegating follow-up care to physician assistants, and other clerical matters.

Public comments will be accepted on proposed guideline updates until December 19, 2025.

The fee schedule has not been updated since 2009, resulting in low reimbursement rates, which has impacted access to care.

Proposed updates also allow for electronic filing and service of all WCAB case related documents in EAMS rather than requiring service by mail.