Bulletin No. 30-06
May 25, 2006

DWC proposes regulations to close loop hole regarding the pharmacy fee schedule

The Division of Workers' Compensation is proposing regulations to close a loop hole created from legislation passed in 2003, and is posting the proposed regulations on line.

Currently, the legislation requires that reimbursement rates for medical services, except physician fees, are in accordance with the relevant Medicare and Medi-Cal payment systems. However, those systems do not allow drugs to be dispensed by doctors in their office. This exception allows doctors to be reimbursed for drugs dispensed during offices visits at much higher rates than those paid to pharmacies for the same drugs, thereby, creating a loophole in the reimbursement structure. The DWC proposed regulations close that loophole.

The proposed regulations will be posted on an online forum for members of the public to review and comment. The forum can be found at: http://www.dir.ca.gov/Wcjudicial.htm. Please click on "current forums" at the top of the page.

Comments will be accepted on the forum through Monday, Jun. 12, 2006. Please feel free to participate in this important process.