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The problem
The Workers' Compensation Risk Equation
- Regulatory Surprise
- Margin Compression
- Enforcement Exposure
For multi-state workers’ compensation platforms, regulatory change is no longer incremental. States are increasing scrutiny of physician dispensing, expanding PBM transparency mandates, tightening TPA licensing requirements, and revisiting employer direction-of-care frameworks.
One state statute can:
- Alter reimbursement methodology
- Restrict repackaged drug markups
- Require new license filings
- Change network penetration dynamics
- Trigger enforcement exposure
Most organizations react after a change is enacted.
The Regulatory Risk Monitor is designed to identify risks before they become operational disruptions.
What We Monitor
50-State Regulatory Coverage Across Four Domains:
1. Physician Dispensing Rules
- Reimbursement caps and fee schedule limitations
- Repackaged and compounded drug restrictions
- In-office dispensing eligibility rules
- Mandatory generic substitution mandates
- Enforcement trends and litigation exposure
2. PBM Licensure & Regulation
- State PBM registration and licensing requirements
- Transparency and rebate disclosure mandates
- Audit authority expansion
- Anti-spread pricing legislation
- Reporting obligations to insurance departments
3. Direction of Care Laws
- Employer vs employee choice frameworks
- Initial provider selection restrictions
- Referral control limitations
- Network participation mandates
- Impact on pharmacy network penetration
4. TPA Licensure & Regulatory Changes
- State TPA licensing requirements
- Surety bond mandates
- Claims handling compliance standards
- Regulatory changes affecting PBM–TPA relationships
- Multi-state operational risk alerts
What You Receive Each Month:
Monitoring Infrastructure
- 50-state legislative and regulatory tracking
- State risk classification dashboard
- Effective-date implementation calendar
Strategic Intelligence
- Executive impact summary
- Margin exposure analysis
- Jurisdictional risk scoring
- Identification of emerging enforcement patterns
Executive Advisory
- Monthly executive briefing
- Ongoing regulatory interpretation support
- State-specific implementation discussion
This is delivered through a structured monthly subscription model.
Who This Is For
The Regulatory Risk Monitor is designed for:
- Regional and national PBMs
- Workers’ compensation TPAs
- Self-insured platforms operating across multiple states
- PPO networks and ancillary service providers
- Self-Insured Groups and Self-Insured Employers
- Workers' Compensation Insurance Companies
The First 90 Days
Within the first 90 days, SRX Advisors will:
- Review your operational footprint by state
- Assess physician dispensing exposure by jurisdiction
- Identify highest regulatory risk states
- Build a customized state tracker
- Establish executive reporting cadence
- Flag 3–5 immediate risk areas
Your first executive brief is delivered within 30 days
Why SRX
Dennis M. Sponer founded one of the first workers’ compensation-focused PBMs in the country. The company was sold in a transaction valued at 13x EBITDA, and it was later integrated into Optum Healthcare Solutions. He has firsthand experience with:
- PBM margin dynamics
- Drug pricing structures
- Network penetration strategy
- Regulatory scrutiny at scale
This product was built from operational experience—not from a theoretical compliance perspective.