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Release Number: 2024-44
Date: June 13, 2024

DWC Issues Notice of 15-Day Public Comment Period for Rulemaking Action to Adopt Revisions to the Official Medical Fee Schedule (Pharmaceuticals)

The Division of Workers’ Compensation (DWC) held a public hearing on April 11 and received public comments on proposed amendments to the Official Medical Fee Schedule provisions relating to pharmaceuticals dispensed to injured workers. DWC has considered comments received in the public comment period and has made modifications to the proposal in light of comments received and to clarify the provisions of the proposed amendments.

Some of the changes proposed in the modified regulations include:

  • Modifying the effective date of the amendments from 90 days to the first day of the month following 180 days after the regulations are filed with the Secretary of State
  • Modifying the current regulation that will continue in effect for services prior to the effective date of amendments to better identify the current data file and current compounding fee/sterility fee table
  • Proposing a new section relating to the Pharmaceutical Fee Data File and National Provider Identifier (NPI) File to consolidate provisions and improve clarity
    • Defines the “lowest cost” and “no substitution cost”
    • Specifies that Pharmaceutical Fee Data Files and NPI Files will be updated weekly
    • Specifies that the NPI Data File provides the list of pharmacies eligible for the higher tier dispensing fee
    • Provides rules for implementation of the weekly updates and provisions related to retroactive changes
    • Deletes parallel provisions from other sections to avoid duplication
  • Modifying rules to allow a physician to receive a dispensing fee, compounding fee and sterility fee; setting the dispensing fee at the lower tier which is applicable for all dispensers that are not listed on the Medi-Cal pharmacy NPI Data File
  • Modifying regulation text to improve clarity of the provisions.

The Notice of Modification to Text of Proposed Regulations, the text of the modified regulations, and information on how to submit comments can be found on the DWC rulemaking page. The comment period will close at 11:59 p.m. on June 28, 2024.