State of the States Jan. 17, 2025

National – he Federal Trade Commission (FTC) published a second report criticizing pharmacy benefit managers (PBMs) like CVS’ Caremark, Cigna’s Express Scripts, and UnitedHealth’s OptumRx. The report highlights significant drug price markups, with PBMs inflating costs by hundreds or thousands of percent. According to the report, the FTC’s findings suggest these practices have generated $7.3 billion in revenue from 2017 to 2022 while increasing drug costs for patients and squeezing independent pharmacies.

Montana – wo bills were introduced in the Montana State Legislature to expand treatment options by physician assistants and physical therapists:

• Senator Greg Hertz (R) introduced SB 109, which proposes adding physical therapists to the statutory list of primary treating physicians responsible for coordinating and delivering medical care to injured workers.
• Representative Jodee Etchart (R) introduced HB 143, which seeks to repeal the statutory language that restricts physician assistants to serve as treating physicians only in the absence of a licensed physician in the area.

Texas – The Texas Department of Insurance will host a one-hour webinar on January 30th to provide tips for utilization review agent (URA) applications. The webinar will cover the URA application process, including submission and renewal procedures, and offer helpful tips to streamline the process.

Virginia – SB 1299, introduced in the Senate this week, creates an exception to the Virginia Workers’ Compensation Act. It allows employees to sue their employers for damages if their injury or death is due to the employer’s gross negligence or willful misconduct instead of just claiming workers’ compensation.

SB 1301 and HB 2060 both propose to improve workers’ compensation benefits for law enforcement officers and firefighters who develop post-traumatic stress disorder (PTSD), anxiety disorder, or depressive disorder due to their work. The bill suggests doubling the maximum benefit period for anxiety and depressive disorders from 52 weeks to 104 weeks and extending the maximum benefit period for PTSD from 52 weeks to 500 weeks.

SB 1112  and HB 2481 both aim to include injuries or diseases caused by repetitive and sustained physical stressors under the Virginia Workers’ Compensation Act. This encompasses conditions resulting from repetitive motions, exertions, posture stresses, contact stresses, vibrations, or noises.

SB 860 was discussed at a Senate Commerce and Labor Committee this week. As a reminder, the bill aims to increase workers’ compensation benefits for law enforcement officers and firefighters suffering from post-traumatic stress disorder (PTSD), anxiety, or depression incurred in the line of duty. The bill extends the maximum duration of benefits from 52 weeks to 500 weeks and removes limitations on medical treatment and incapacity benefits. It also broadens the definition of law-enforcement officers to include civilian crime scene investigators for these claims. This legislation seeks to provide more comprehensive support for those facing significant mental health challenges due to their service.

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