Lara Heal is the Vice President of Specialty Network Services at CorVel Corporation, where she oversees the company’s CareIQ, Pharmacy, and IME service lines. She brings more than 25 years of experience in the healthcare industry, including a decade of leadership in case management and vocational rehabilitation services. A registered nurse (RN), certified case manager (CCM), and certified Workers’ Compensation Professional (WCP®), she has deep expertise in workers’ compensation, disability management, managed care, and clinical operations. Heal is recognized for her clinical expertise, operational leadership, and extensive industry knowledge. She holds a bachelor’s degree in nursing from the University of Southern Maine.
From global supply chain instability to emerging state regulations, pharmacy management is shaped by factors that vary widely in scope but nonetheless exert significant impact.
In 2025, ongoing drug shortages and increased regulatory pressures directed at coverage and costs underscored the need for workers’ compensation leaders to further optimize pharmacy programs, with an emphasis on strategic cost containment and clinical oversight.
At the same time, new applications of predictive analytics and a strengthened focus on whole-person health present key opportunities to enhance outcomes for injured workers—from accelerated recovery to a more streamlined return-to-work.
Reflecting on 2025, it’s clear that no pharmacy trend is too small to impact how injured workers receive care. In 2026, market and regulatory shifts will continue to build on these existing trends, making waves in the coming year.
Drug Shortages Disrupt the Status Quo
In the U.S., an estimated 84% of drug shortages involve generics. Recent FDA and ASHP reports reinforce that most active shortages involve generic medications. Ongoing raw materials constraints, manufacturing quality issues, and rising demand will continue to drive fluctuations in generic pricing and volumes through 2026.
Drug shortages have a disproportionate impact on injured workers. Whether a construction worker recovering from surgery or a truck driver rehabilitating a sprain, lack of access to basic medications can delay recovery and extend temporary total disability (TTD).
To keep medications flowing and recovery plans on track, payers are increasingly evaluating or adopting direct-to-payer or mail-order models. These solutions complement cost containment measures, such as converting high-cost medications to cost-effective equivalents.
States Get Stricter on Pharmacy Spending
According to recent reports, more than thirty states, including California, Oregon, and New York, have passed laws aimed at increasing drug pricing transparency and reducing drug costs. These laws come on the heels of legislation granting Prescription Drug Affordability Boards (PDAB) the authority to set upper payment limits in states like Colorado and Maryland.
States with historically unstandardized drug pricing, such as Pennsylvania are highlighting the financial risks associated with inconsistent pricing sources. Many states are expected to address these challenges with further regulatory action intended to prevent fraud, waste, and misuse while improving payment accuracy.
Swift adaptation to these evolving regulations will be essential. Pharmacy programs that proactively align with standardized pricing sources will gain an advantage in reducing payment disputes and accelerating approvals, ensuring cost-effective, high-quality care.
Mental Health Moves to the Forefront
Conversations about mental health care in workers’ compensation gained significant momentum in 2025, driven largely by expanded state coverage for job-related psychological injuries. This trend will continue in 2026 as more states look to broaden access across industries and employment environments.
Increased mental health awareness also impacts pharmacy management. This is driven by a renewed focus on early intervention measures, including post-injury check-ins or psychosocial support, which may help reduce acute symptoms and decrease the likelihood that medication therapy becomes necessary.
Parallel measures, such as behavioral health virtual care and predictive scoring tools, will play a key role in identifying whether an injury is evolving into depression, anxiety, or post-traumatic stress disorder (PTSD). Early detection helps pharmacy and clinical teams anticipate how these conditions may influence prescribing patterns, particularly around antidepressants and other medications used to manage pain-related or psychologically-related symptoms.
Technology Drives Progress
In 2026, predictive intelligence applications will continue to advance. AI-powered tools will help pharmacy, clinical, and claims teams optimize pharmacy spend, enhance medication adherence, and improve drug safety.
When integrated with a claimant’s medical history, advanced pharmacy management platforms can enable teams to flag preexisting conditions or identify potential drug interactions. AI will take these applications one step further, expanding visibility into pharmacy data and enhancing clinical modeling capabilities.
By accelerating oversight, AI empowers claim handlers and clinicians to leverage direct intervention where it matters most: high-risk cases that require personalized intervention.
Holistic and Value-Based Care Gain Momentum
The first 30 days following a workplace injury often set the tone for the entire claim. As advocacy for holistic care gains new momentum, pharmacy programs must increasingly integrate biopsychosocial care models that account for social and environmental factors—such as transportation barriers or caregiver responsibilities—that may influence risk and recovery outcomes.
In the same vein, as pharmacy management shifts to prioritize holistic care, programs will also show growing interest in value-based care in 2026. Within these models, dispensing decisions align with evidence-based treatments, and provider reimbursement is linked to patient outcomes.
Both models offer a path towards outcomes-driven pharmacy management and whole-person care.
Looking Ahead
As workers’ compensation pharmacy management enters its next chapter, innovation, flexibility, and resourcefulness will prove integral. By adapting to shifting market conditions, regulatory demands, and clinical standards, payers and employers can uphold quality benchmarks, ensuring injured workers receive timely, cost-effective, and holistic care. &
Clinton Mora is a reporter for Trending Insurance News. He has previously worked for the Forbes. As a contributor to Trending Insurance News, Clinton covers emerging a wide range of property and casualty insurance related stories.