Workers' compensation pharmaceutical fee schedule - Update Information
NOTICE: The pharmaceutical fee schedule is revised for dates of service on or after July 1, 2025. Updated Pharmaceutical Fee Data Files and National Provider Identifier Files will be posted on a weekly basis beginning shortly before the July 1, 2025, effective date. The new fee schedule implements a revised pricing methodology based upon Medi-Cal changes and implements provisions of Labor Code section 5307.1 related to physician dispensing of pharmaceuticals. You may review details of the revisions on the DWC Approved Regulations webpage. To assist the public, sample data files are being provided to allow programming of business systems used for pharmaceutical billing or bill review and payment. A new Pharmaceutical Fee Calculator will be provided as a service for the public. It is anticipated that further sample files will be issued, and the calculator will be made available for a public beta testing period in the first quarter of 2025. Further information will be provided in the coming weeks. Notices relating to the Pharmaceutical Fee Schedule will be sent to the DWC Newsline mailing list. You may subscribe to the DWC Newsline mailing list on the DIR subscription web page.
Please send comments or questions to DWCFeeSchedule@dir.ca.gov.
Sample Pharmaceutical Fee Schedule and National Provider Identifier data files for new fee schedule
The data files are presented for use by the public in programming billing and payment systems; they are NOT currently effective for payment. For modeling and system development purposes only these files assume an implementation date of January 1, 2023.
- SAMPLE Pharmaceutical Fee Data File NOT for Current Pricing pfs_run20241216
- SAMPLE NPI pharmacy dispensing fee NOT for Current Pricing npi_run20241216
Resources
- Labor Code section 5307.1
- Regulation Text
- California DWC Medical Billing and Payment Guide
- California DWC Electronic Medical Billing and Payment Companion Guide
- California Board of Pharmacy - Pharmacy Law Book
- Business & Professions Code § 4170 – Prescriber Dispensing
- FDA National Drug Code Directory – Finished Drug Product Database / Unfinished Drug Database
- FDA Orange Book – Approved Drug Products with Therapeutic Equivalence Evaluations
- FDA Purple Book – Database of Licensed Biological Products
- National Plan & Provider Enumeration System – National Provider Identifier search tool
- NDC 10 to NDC 11 Conversion Chart
December 2024