Effective July 1st, certain violations of workers’ comp law will see a 12.11% increase in penalties.
Effective July 1st, certain violations of workers’ comp law will see a 12.11% increase in penalties.
This development signals a shift toward a standardized OWCP pharmacy model that could impact Longshore and Black Lung claimants.
Three in-progress bills impact medical reimbursement and fee schedules, prescription drug authorizations, and medical necessity evaluations.
Senate Bill 1215 was discussed, and it appears unlikely the proposed reimbursement caps will be passed.
Matters discussed included physician dispensing, missed appointment fees, passive therapy utilization, and interpreter bill denials.
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.
A new West Virginia PBM bill, effective immediately, prohibits spread pricing and requires PBM fees to be transparent and independent of drug cost.
On March 31, Louisiana introduced a bill that would change how Medical Maximum Improvement (MMI) is defined and how wage-loss benefits are paid.
Two Oklahoma bills heading for House consideration would establish a NADAC based reimbursement floor, minimum dispensing fees, and a shortened 30 day payment timeframe.
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.
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.
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).
The updated schedule increases the maximum reimbursement for topical compounds and urges pharmacies to select the lowest-AWP medication when available, among other changes.
Additionally, the bill would update the fee schedule and impact billing and utilization requirements.
The updated fee schedule will go into effect April 1st, while a new IME subcommittee will evaluate cost and practice concerns.
