State of the States June 20, 2025

National – The Center for Medicare and Medicaid Services (CMS) hosted a webinar titled "Introduction to Workers’ Compensation Medicare Set-Asides (WCMSA)" on June 17th at 2 PM. The webinar aimed to cover the fundamentals of WCMSAs, including their purpose, submission guidelines, and administration. Additionally, it provided best practices for managing WCMSAs. If you missed the webinar, check out this What’s New section on the CMS website.  

The U.S. Department of Labor launched an opinion letter program to provide clear guidance on federal labor laws across five key agencies: the Wage and Hour Division, Workplace Safety and Health Occupational Safety, Employee Benefits Security Administration, Mine Safety and Health Administration, and Veterans’ Employment and Training Service. The website details how to request an opinion letter, offers tips for writing, and explains the submission process. 

Drug Channels Institute (DCI) released an analysis highlighting that pharmacy benefit manager (PBM)-affiliated specialty pharmacies control the majority of the specialty drug market. The report reveals that nearly 1,900 accredited specialty pharmacy locations are responsible for approximately two-thirds of prescription revenues from pharmacy-dispensed specialty medications. The analysis also notes the growing presence of provider- and health system-owned dispensing channels, indicating evolving dynamics within this market segment. To learn more, check out this website.

Florida – Florida’s legislative session ended this week on June 15th, and several bills did not progress and ultimately died in committee: 

• • • HB 87 died in the Government Operations Subcommittee. As a reminder, HB 87 was designed to expand the list of cancers covered under a statutory scheme that provides benefits to firefighters as an alternative to workers’ compensation. The proposed legislation would include acute myeloid leukemia. 
      
  • SB 366 died in the Community Affairs Committee. As a reminder, SB 366 would have enhanced disability benefits for firefighters, law enforcement officers, and correctional officers by establishing a presumption that certain health conditions, such as heart disease, tuberculosis, and hypertension, are incurred in the line of duty unless proven otherwise. 
  • HB 1281 died in the Insurance & Banking Subcommittee. As a reminder, HB 1281 aimed to streamline workers’ compensation processes by revising the duties and responsibilities of the Department of Financial Services (DFS) and the Chief Financial Officer (CFO). 
  • HB 1069 died in the Insurance & Banking Subcommittee. As a reminder, HB 1069 proposed allowing businesses to create their own programs to compensate workers for occupational injuries as an alternative to the state’s workers’ compensation system. The bill specifies that these plans must cover medical expenses for at least 156 weeks and provide indemnity benefits at a minimum of 75% of the worker’s average weekly wage. 

Iowa – SF 383 was enacted by Governor Kim Reynolds this week. As a reminder, SF 383 aims to increase transparency, fairness, and consumer choice in the management of pharmacy benefits and prescription drug pricing. Specifically, the bill prohibits PBMs from discriminating against pharmacies, mandates fair reimbursement based on national averages, and requires quarterly reporting of reimbursement rates.

New Jersey – A 5792 was introduced this week. If passed, A 5792 would provide workers’ compensation coverage for counseling services for first responders. Specifically, the bill would require employers of first responders to provide up to 12 hours of paid confidential counseling with a licensed mental health professional for critical incidents, plus an additional 24 hours if necessary. According to the bill text, first responders would include paid 911 dispatchers, law enforcement officers, paid firefighters, and members of emergency response teams.

Oregon – The Oregon Department of Consumer and Business Services (DCBS) released its biennial workers' compensation study, ranking all 50 states and Washington, D.C., based on premium rates effective January 1, 2024. The study reveals that Oregon's workers' compensation rates remain among the lowest in the nation. In contrast, Hawaii has the most expensive workers' compensation rates, followed by New Jersey, New York, and California.

Industry Watch 

The White House Can Lower Drug Prices By Fixing The Market, Not Price Controls

Washington, D.C. (June 16)- Why do we have a medical system in this country where too many people can’t get the treatment that they need?” Vice President J.D. Vance posed this question during his recent appearance on This Past Weekend w/ Theo Von — and it cuts to the core of America’s health care challenges. To read the full article, click here.   

Inflation Impacting Workers’ Comp Medical Costs: WCRI  

Insurance Journal (June 16)- A new study by the Workers Compensation Research Institute (WCRI) illustrates how rising inflation has impacted the system in recent years. The 2025 edition of the WCRI Medical Price Index for Workers’ Compensation, authored by Dr. Rebecca Yang and Dr. Olesya Fomenko, analyzed the cost for medical services including evaluation and management, physical medicine, surgery, radiology, neurological testing, pain management injections, and emergency care — typically billed by physicians, physical therapists, and chiropractors. To learn more, check out the full article here. 

Massachusetts Denies 7.1% Workers’ Compensation Rate Hike After 2024 Excessive Cut

Insurance Journal (June 16)- As a result, existing rates, which reflect a 14.6% decrease ordered last July, will remain in effect for policies on and after July 1, 2025. The ruling is a setback for the industry’s rate filing organization, the Workers’ Compensation Rating and Inspection Bureau (WCRIB), which criticized last year’s decrease as “excessive” and “unreasonable.” The 2024 reduction was nearly double what WCRIB recommended (-7.6%) for a cut. Check out the full Insurance Journal article here.  

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