National –
- The Workers’ Compensation Research Institute (WCRI) released a free, on-demand webinar highlighting findings from its 32-state study, Use and Cost of Air Ambulance Transport Services in Workers’ Compensation—A WCRI FlashReport, which examines costs, access to services, and variations in use across rural and non-rural areas.
- Tower MSA Partners released Workers’ Compensation Medicare Secondary Payer (MSP) Outcomes & Regulatory Insights Report, analyzing aggregated performance data from 2022–2025. The report includes benchmarks related to Medicare Set-Aside (MSA) outcomes, CMS approval trends, pharmacy interventions, and conditional payment resolution. It reports annual reductions in projected MSA amounts ranging from 33% to 64%, average CMS-approved MSAs that were 23% lower than national averages, and annual MSA-related savings between $9 million and $12 million.
Arizona – Two bills advance to the Governor’s desk this week:
- SB 1215 passed both the House and Senate and will be sent to the Governor’s desk for consideration, while HB 2231 remains in the Senate for further consideration. As a reminder, SB 1215 and HB 2231 are companion bills aiming to ensure firefighters receive full workers’ compensation protections by correcting a punctuation error that insurers have exploited to deny cancer claims. The measures clarify adenocarcinoma is a standalone cancer presumed to be work-related under Arizona’s presumptive cancer law, closing a loophole that allowed insurers to argue coverage applied only to adenocarcinoma of the respiratory tract. By explicitly correcting the statute, the bills ensure firefighters diagnosed with cancer can access the benefits intended for them without unnecessary obstacles.
- SB 1428 – As a reminder, SB 1428 would establish new requirements for zero estimated exposure workers’ compensation policies. The bill requires employers to attest that they have no employees and no payroll exposure, and to notify their insurer within 60 days if an employee is hired. The intent is to improve transparency and ensure policies accurately reflect an employer’s workforce, helping promote appropriate underwriting and reduce the potential for disputes.
Hawaii – Despite expectations that the bills would pass easily, SB 2751 and its companion, HB 2164, both died before the close of the session. As a reminder, if enacted, they would have established standards for the regulation and reimbursement of prescription drugs for injured workers within Hawaii’s workers’ compensation system. It would have limited physicians to dispensing prescription medications only during the first 30 days following an industrial injury, after which prescriptions would need to be filled through the employer’s pharmacy benefit manager (PBM) network.
Pennsylvania – In 700 Pharmacy v. SWIF, the Pennsylvania Supreme Court issued a decision this week holding that the Workers’ Compensation Act’s anti-referral provision does not extend to prescription drugs or pharmacy services, concluding the statute’s plain language limits the prohibition to a closed list of enumerated services. The Court rejected the broader interpretation adopted by the Commonwealth Court, emphasizing “goods or services” is not a catch-all and courts cannot expand the statute beyond what the legislature expressly included. In effect, the decision signals that while the legislature may choose to regulate these arrangements, the statute as written does not do so.
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