A small number of high-cost meloxicam capsule prescriptions sharply increased the drug’s average payment from $9 in 2020 to $92 in 2025.
A small number of high-cost meloxicam capsule prescriptions sharply increased the drug’s average payment from $9 in 2020 to $92 in 2025.
RVUs will be utilized to account for differences in resource intensity, instead of tracking just the number of medical transactions.
Spending remains high despite limits passed in 2025, with patterns of duplicate therapy, lack of medical necessity, and changes in drug strength.
The rule updates impact several areas of workers’ comp, ranging from pharmacy reimbursement, DME, telemedicine, and much more.
The November 3rd meeting will provide the public a chance to comment on fee schedule rules and other regulations.
The proposed changes will have a 45-day public comment period for stakeholders to provide feedback.
The report focuses on changes made to the Physician Fee Schedule, for Facility Payment Systems, and for the DMEPOS Fee Schedule.
The change aligns workers’ comp rules with a February 2026 court ruling on pharmacy choice.
Impacted drugs include physician-dispensed and repackaged drugs, topicals, compounds, and OTC medications.
Proposed changes would impact reimbursement for telehealth, evaluation and management, and more.
The cap is for a 30-day supply. If actual acquisition cost exceeds $300, reimbursement would be limited to 120% of documented AAC.
Impacted items would include pharmacy and topical reimbursement, home health, prior authorization, and more.
Stakeholder feedback for the audit plan will be accepted until 5:00 PM CST on August 6th.
The August 20th webinar will discuss the impact of PBM legislation on workers' compensation systems.
Updates to the Practitioner Fee Schedule switch from an AWP-plus reimbursement model to an AWP-discount model.
