Federal Focus A postal worker’s failure to submit medical evidence justifying the need for a nonformulary, name‑brand medication led ECAB to affirm OWCP’s denial of authorization. Simply Research subscribers have access to the full text […]

By Dennis M. Sponer, J.D., LL.M., MBA | May 2026  Three major developments in May warrant the attention of all workers’ compensation professionals overseeing pharmacy or PBM programs. Two have immediate operational impacts, while the […]

Beneath the Surface Trust has long existed as an assumption within many workers’ compensation pharmacy relationships. Prescriptions processed, reports generated, and claims moved forward without requiring employers or claims organizations to examine the structure driving […]

Beneath the Surface Most workers’ compensation leaders are not spending their day analyzing pharmacy benefit management structures, and on the surface, there is little reason to. Prescriptions continue moving through the system, injured workers receive medications, and […]

Workers' Comp Pharmacy Update Three changes in the law that affected April should be understood by every workers' compensation expert who tracks pharmacy or PBM programs. Two have immediate effects on operations, and one is changing the competitive landscape in ways […]

Most workers’ compensation leaders are not watching the recent developments surrounding Express Scripts and pharmacy benefit management, and on the surface, there is little reason to. Injured workers are still filling prescriptions, claims are still moving, and pharmacy programs appear […]

The Express Scripts racketeering allegations are forcing a level of scrutiny that the workers’ compensation industry can no longer ignore. Conversations across the market are centering on rebate structures, transparency, and the role financial incentives […]

Sarasota, FL (WorkersCompensation.com) – Originally created in the 1960’s, pharmacy benefit managers (PBMs) are the middleman between drug manufacturers and insurers or employers. PBMs serve as a negotiator of rebates with drug manufacturers, in addition […]