In 2024, the New Mexico Workers’ Compensation Administration (WCA) proposed rule changes to several areas of their regulations, including 11.4.7.9 (D)(6), which would impact the provider dispensed days’ supply limit and prior authorization for renewal prescriptions. Recently, these proposed rule changes were withdrawn by the state. As explained in our October 2024 post, the changes would have increased the days’ supply requirements from 10 days to 14 days and would have disallowed reimbursement for “renewal or refill” prescriptions if pre-authorization was not obtained.
The WCA withdrawal was a result of multiple negative public comments submitted. MyMatrixx submitted comments to support more control of physician dispensing, and we suggested some clarifying language. For now, this section of the rule in Part 7 will remain unchanged. Other proposed changes to Part 7 were also withdrawn. The state has concluded these topics may be addressed in future rule making.
However, the WCA did adopt other proposed changes regarding payment of claims, claims resolution and proof of coverage. See this link for further detail.
Moving Forward
In light of the public comments received, the WCA noted it will resume work on Part 7 in future rulemakings. MyMatrixx will track any related developments.
Questions on this topic for our Regulatory Affairs team can be sent to MMXRegulatoryAffairs@MyMatrixx.com. For more information on policy developments like this in workers’ compensation impacting pharmacy in states across the country, please visit and bookmark Statehouse Watch at MyMatrixx.com.