Several states are implementing or proposing 2026 workers’ compensation medical and pharmacy changes, including updated fee schedules (AK, SC, TN, MS, OK, AL), increased focus on pharmacy reimbursement and physician dispensing, and new compliance requirements. Florida court action stalled physiciandispensed drug rules, while Louisiana and Pennsylvania are considering costcontrol legislation. New York strengthened eBilling enforcement and expanded provisional medical payments. Texas raised the latepayment interest rate to 7.14%.
Alaska
The Alaska Department of Labor has approved a new Medical Fee Schedule effective on April 1. The updated schedule introduces new reimbursement guidelines for durable medical equipment (DME) rentals, home health services, and medical evaluations. The fee schedule is available on the Department’s website.
Alabama
The Alabama Division of Workers’ Compensation typically updates its fee scheduled annually on the first day of March. However, as of the final day of March this year, the 2026 updated fee schedules had not been posted to the Division’s website. Despite this possible oversight, Optum has confirmed that updates have actually been enacted and will be retroactively backdated to March 1, 2026, regardless of when the final adopted fee schedule is posted online.
The new fee schedule includes changes to reimbursement rates for various medical services, increases in dispensing fees for both brand and generic medications, and updates to other per-diem charges and therapy-related fees. Copies of all 2026 fee schedules may be obtained by emailing the regulator directly at Craig.White@workforce.alabama.gov.
Florida
On February 25, the Florida First District Court of Appeals issued a decision in Publix Super Markets, Inc., et al. v. Department of Financial Services, Division of Workers’ Compensation, et al., invalidating proposed rules that would have required carriers to authorize and reimburse medications dispensed by physicians and other non-pharmacist providers under Florida’s “absolute choice” law.
The initial deadline to appeal has passed, although the parties may still seek review by the Florida Supreme Court. In addition, legislation may be introduced during the next session to address this issue, potentially by amending section 440.13(3)(j) to include the phrase “dispensing physician.” The full decision may be found at this link.
Louisiana
The Louisiana Legislature is considering two bills that would significantly impact the provision of medical care to injured workers.
- HB 819 would require the Louisiana Workforce Commission to discontinue the current Medical Treatment Guidelines and adopt the ODG Official Disability Guidelines for all medical treatment decisions.
- HB 357 would require the development of a new Medical Treatment Fee Schedule no later than January 1, 2027.
Both bills have been provisionally referred to the House Committee on Labor and Industrial Relations.
Mississippi
The Mississippi Workers’ Compensation Commission has proposed a new Medical Fee Schedule to take effect on June 1, 2026. The proposal includes reduced reimbursement rates for brand and generic drugs, limits on physician dispensing, prior authorization requirements for compound medications, caps on reimbursement for topical medications, and changes to billing review and pain management rules.
The proposed fee schedule is available on the Commission’s website.
New York
The New York Workers’ Compensation Board (WCB) recently issued guidance regarding electronic submission of CMS-1500 bills. The WCB reminded payers that providers may recoup eBilling submission costs—up to a maximum of $1.00—by using CPT code 99080 on the CMS-1500 form. The Board also emphasized proper eBill processing and acceptance, noting that a $50 penalty may be assessed for each instance of non-payment when providers submit bills using the correct format and transmission method. Additional information can be found on the WCB’s CMS-1500 eBilling project page.
Governor Hochul recently signed an executive order amending Section 21a of the Workers’ Compensation Law to expand payers’ ability to handle claims pending acceptance. Effective January 1, 2027, payers may provisionally pay for medical care without admitting liability. Previously, provisional payments were limited to indemnity benefits and prescription medication. The WCB has proposed implementing regulations, which are available in the State Register and on the Board’s website.
As of April 1, the WCB no longer accepted faxed submissions of claim-related documents, including Independent Medical Examination (IME) reports. IME reports must be submitted on the same day and in the same manner to all required parties, including the injured worker. The elimination of fax submissions is part of WCB’s efforts to improve claim processing efficiency and accuracy.
New York State Assembly Bill 10413 would allow injured workers to obtain prescription medications outside of employer or insurer pharmacy networks when delays or authorization issues occur. The bill would amend existing law permitting employers to use pharmacy benefit networks and direct claimants to network pharmacies. Similar legislation was vetoed by the Governor last year. The bill is currently pending in the Assembly Labor Committee.
Find out more here.
Oklahoma
The Oklahoma Workers’ Compensation Commission has released a draft update to its Medical Fee Schedule, with a proposed effective date of July 1, 2026. Changes from the current 2024 schedule include updates to CPT, HCPCS, and CDT codes and descriptions, as well as updated maximum allowable rates based on CMS Relative Value Units.
No fee increases or decreases greater than 10% are proposed compared to 2024 rates, with limited exceptions for certain surgical codes. No changes are proposed to pharmaceutical services or DME ground rules. The draft Medical Fee Schedule and a summary of proposed changes are available on the Commission’s website.
Pennsylvania
SB 1215 seeks to address excessive costs for prescription topical drugs in workers’ compensation. Further information on the bill can be found here.
South Carolina
A new Medical Fee Schedule has been approved by the South Carolina Workers’ Compensation Commission as of April 1, 2026. A copy of the fee schedule can be purchased from FairHealth here.
Tennessee
The Tennessee Department of Labor and Workforce Development has released its annual updates to the Workers’ Compensation Medical Fee Schedule Handbook, effective as of April 1 this year.
The pharmacy section of the Handbook now states that MediSpan Price Alert is the primary source and Red Book is the secondary source for determining Average Wholesale Price (AWP). The prior edition of the Handbook did not specify a hierarchy for AWP source selection.
Although there are no substantive changes to the DME section, Maximum Allowable Reimbursement (MAR) calculations for general medicine, therapy, chiropractic services, evaluation & management, and home health services have been adjusted for inflation. Additionally, for physician professional services, the OP modifier has been retired and replaced with the CP modifier.
The full handbook is available on the Department’s website.
Texas
The Texas Division of Workers’ Compensation has updated the interest rate used to calculate late payment penalties for medical services and indemnity benefits pursuant to the Texas Labor Code. The new rate is 7.14%, effective April 1, 2026, through June 30, 2026. Additional information is available on the Division’s website Discount rate/interest rate.