Advocacy & Compliance

Healthesystems’ Advocacy & Compliance experts are essential in the management of pharmacy and ancillary benefits for our clients. By tracking and influencing regulatory activity, our team stays ahead of evolving trends and identifies opportunities to advocate on behalf of our clients, their injured workers, and the broader industry.

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The Advocacy &  Compliance Team

Monitors and reports on proposed and pending regulatory changes that impact workers' comp, helping shape effective program strategies

Advocates for fair and balanced public policy through proactive engagement with regulators, customers, and other stakeholders throughout the rulemaking lifecycle

Supports operational compliance by providing guidance to internal stakeholders and external partners during the implementation of new regulatory changes

Regulatory Recap

A weekly e-newsletter informed by the Advocacy & Compliance team to help keep our clients and industry contacts in the know on the latest legislation and policy updates impacting workers’ comp.

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Spotlight

Billing & Payments

Louisiana Bill Would Remove Prescription Drugs from MTS Authorization and Appeals

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.

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April 6, 2026

Spotlight

Advocacy Opportunity Billing & Payments

Oklahoma Bills Would Create Conflicts for Workers’ Compensation Pharmacy

Two Oklahoma bills heading for House consideration would establish a NADAC based reimbursement floor, minimum dispensing fees, and a shortened 30 day payment timeframe.

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March 30, 2026

Billing & Payments

West Virginia PBM Bill Bans Spread Pricing

A new West Virginia PBM bill, effective immediately, prohibits spread pricing and requires PBM fees to be transparent and independent of drug cost.

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April 6, 2026

Mental Health Presumptions

Wisconsin Agreed Bill Expands PTSD Eligibility

On March 31, Wisconsin passed a bill expanding PTSD‑only workers’ compensation claim eligibility for certain first responders and adopting a broader package of agreed‑upon reforms.

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April 6, 2026

Access to Care Claim Costs Industry Data

WCRI Study Finds Provider Networks Improve Claim Outcomes

A new study from the Workers Compensation Research Institute found that injured workers treated in medical provider networks have lower medical and total claim costs, faster access to care, and improved disability outcomes.

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April 6, 2026

Industry Data Worker Safety

NCCI Highlights 2026 Legislative and Regulatory Trends

NCCI’s 2026 Emerging Legislative and Regulatory Issues report identifies heat exposure, workplace violence, and broader workers’ compensation system changes as key areas impacting workers’ compensation programs.

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April 6, 2026

Billing & Payments

Louisiana Bill Would Modify Key Parts of State’s Workers’ Compensation System

On March 31, Louisiana introduced a bill that would change how Medical Maximum Improvement (MMI) is defined and how wage-loss benefits are paid.

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April 6, 2026

Cost Containment

Pennsylvania Proposes Price Caps on Compound and Topical Drugs

Senate Bill 1215 proposes a $400, 30-day supply cap for compound drugs and a $240, 30-day supply cap for non-compound topicals.

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March 23, 2026

Ancillary Services Billing & Payments

DME Vendors Are Not “Providers” Under Pennsylvania Workers’ Comp Law

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.

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March 30, 2026

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Further resources you may be interested in

Additional articles and updates from Healthesystems related to policy shaping workers’ comp.

Florida Appeals Court Rules in Favor of Carriers and Employers on Physician-Dispensed Drugs

While injured workers have an absolute choice over their pharmacist, physicians are not considered pharmacists and therefore not entitled to reimbursement.

WCRI Publishes National Repository on Prescription Drug Regulations

While the report addresses multiple topics, a significant focus was given to the expanding role of pharmacists as a healthcare provider.

Expert Q&A: What Utah’s AI Prescription Renewal Pilot Signals About the Evolving Role of AI in Treatment Decisions

Utah’s prescription renewal pilot is a groundbreaking use case for AI in healthcare. What are the potential benefits and pitfalls?

Inside Medical Experience: Signals, Trends, and System Impact

Healthe’s VP of Industry and State Affairs, Sandy Shtab, joins a panel presentation at the Pennsylvania/Delawaare 2026 Workers’ Compensation Symposium.