The change aligns workers’ comp rules with a February 2026 court ruling on pharmacy choice.
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.
The report focuses on changes made to the Physician Fee Schedule, for Facility Payment Systems, and for the DMEPOS Fee Schedule.
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.
The Committee is focused on high-cost and high-utilization medications, including GLP-1s, PPIs, anticonvulsants, topical agents, and biologics.
Commenters asked the DWC to clarify the scope of pharmacy and pharmacist definitions and prior authorization requirements.
The hearing will take place on July 15th, allowing interested stakeholders to attend virtually.
Anti-referral provisions do not prohibit physicians from referring injured workers to pharmacies in which they have a financial interest.
As part of proposed updates to the Healthcare Service rules and the state fee schedule, additional changes are up for debate.
Payments for unlisted professional service more than doubled from 2017-2024.
