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.
The bill would standardize timelines, notice requirements, and dispute resolution processes.
In a February 19th special meeting, the Board approved new rules and addressed confusion regarding resource materials
The bill would allow payers to direct prescriptions to pharmacy networks and create limits for physician dispensing and compounds.
About 6% of medical bills challenged through the dispute process were initially paid correctly.
Employees could be informed of network pharmacies, while out-of-network pharmacies could be denied reimbursement.
One bill conflicts with existing statutes on the timeline to pay pharmacy bills, while another could be preempted by TRICARE law.
Healthesystems played a significant role in reshaping policy surrounding reimbursement for physician dispensing.
Initiatives for 2026 could affect medical billing, pharmacy programs, treatment guidelines, and administrative processes.
After expanding access to care by allowing these providers to treat injured workers, billing guidelines for these providers are being developed.
The case will examine the Bureau of Workers’ Compensation’s use of RED BOOK for calculating AWP.
Effective January 1st, CARC and RARC codes will be permitted for use in EOBs, leveraging nationally recognized standards.
