Senate Bill 1215 proposes a $400, 30-day supply cap for compound drugs and a $240, 30-day supply cap for non-compound topicals.
Senate Bill 1215 proposes a $400, 30-day supply cap for compound drugs and a $240, 30-day supply cap for non-compound topicals.
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.
While injured workers have an absolute choice over their pharmacist, physicians are not considered pharmacists and therefore not entitled to reimbursement.
The state’s definition of “compounded prescription drug” would be updated to fall in line with federal standards.
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.
At a March 11th meeting, the Workers’ Compensation Advisory Council announced a draft expected in fall of 2026 for public comments.
One bill proposes the use of the ODG guidelines, while another bill would establish a fee schedule similar to neighboring states.
While the report addresses multiple topics, a significant focus was given to the expanding role of pharmacists as a healthcare provider.
Changes were made to the Medically Unlikely Edits (MUEs) for Practitioner Services, DME Supplier Services and Outpatient Hospital Services.
Originally meant to address compound medications, the bill has been expanded to create limitations for physician dispensing.
In a February 19th special meeting, the Board approved new rules and addressed confusion regarding resource materials
New bills would address compounds, deadlines for authorization decisions, and more.
The bill would require a formal fee schedule for all services provided under workers’ comp, taking effect August 28, 2026.
