Arizona expected to address topical medications
The Industrial Commission of Arizona is expecting to address reimbursement for prescription topical medications after the holidays. Optum provided data, feedback, and testimony at an October 2025 meeting with industry stakeholders, and has been in contact with the Commission regarding a draft proposal. The October stakeholder meeting can be viewed here.
California to hold public hearing on proposed MTUS updates to PTSD guidelines
The California Division of Workers’ Compensation will be holding a virtual public hearing on December 19, 2025, to discuss proposed evidence-based updates to the Medical Treatment Utilization Schedule (MTUS) specifically related to the PTSD guidelines. The Notice of Proposed Rulemaking, Proposed Administrative Director Order, and information on how to attend the hearing or to submit written comments can be found on the Division’s website here.
Colorado reminds stakeholders to use updated forms
The Colorado Division of Workers’ Compensation has reminded all stakeholders to ensure they are utilizing the current version of any submitted state forms and that beginning January 1, 2026, outdated forms may be rejected. PDF versions of all current state forms can be found on the Division’s website here.
Illinois passes PBM bill
The Illinois Legislature has passed HB 767, a PBM bill that revises a PBM bill passed earlier this year. The new bill provides an exemption for workers’ compensation PBM services in definition of “health benefit plan” and becomes effective January 1, 2026. More information can be found on the Legislature’s website here.
Oregon clarifies self-insurer rules, lowers Workers’ Benefit Fund assessment rate, and raises the claims processing administrative cost factor
New rules regarding Employer/Insurer Coverage Responsibility and the Workers’ Benefit Fund will become effective January 1, 2026. The rules clarify the process that a self-insured employer must follow when appealing the revocation of its self-insurance, and details regarding security and deposit requirements for self-insured employers. Separately, the Workers’ Benefit Fund assessment rate will be lowered to 1.8 cents per hour. The new rules, and a summary of the changes, can be found on the Division of Workers’ Compensation website here.
The Oregon Workers’ Compensation Division has also announced that effective January 1, 2026, the claims processing administrative cost factor will be raised from 18.66% to 19.49%. The Division applies this factor to approved reimbursements for supplemental disability benefits and certain claim costs. They also use this factor in the calculation of self-insured employer security deposits. The Division’s bulletin announcing the change can be read here.
Pennsylvania hears oral arguments on AWP issue
The Supreme Court of Pennsylvania heard oral arguments in Federated Ins. Co. v. Summit Pharmacy (WC) on November 19, 2025. Optum has been engaged with stakeholder groups in discussions of potential legislation around the containment of topicals and clarifying the AWP in the state workers’ compensation statute, which is expected to occur after the Supreme Court issues a ruling in the case. The American Association of Payers, Administrators, and Networks (AAPAN) workers’ compensation PBM sub-group is actively working on feedback and talking points. To listen to the oral arguments, visit the Court’s YouTube channel here.
Washington considers expansion of authorized providers for physical medical services
The Washington Department of Labor and Industries is considering changes to the rule governing which types of providers may provide and be paid for physical medical services to include chiropractors and occupational therapists. The pre-proposal can be viewed on the Division’s website here.