Newsline No. 19-11 printer image Printer friendly
April 14, 2011  

Division of Workers' Compensation pharmaceutical pricing calculator and file downloads are now repaired

The Division of Workers’ Compensation (DWC), in cooperation with the Department of Health Care Services and Hewlett-Packard company (HP), which maintains the Medi-Cal drug pricing database, has corrected a database file download error. The corrected calculator, the first corrected database file for download, and instructions have now been posted on the DWC’s Web site.

As of today, the calculator now returns the correct price for a “Dispensed as Written” (DAW or “no substitutions”) prescription. Reimbursement rates for pharmaceuticals in workers' compensation have been tied to Medi-Cal’s pricing scheme pursuant to Labor Code section 5307.1 (a). Since 2004, the Department of Health Care Services has sent its drug-pricing data to DWC in the form of a large database file, which has been used to publish the DWC calculator of drug prices for workers' compensation. DWC has merely published the portion of the Medi-Cal database it receives, and the calculator accesses the data base directly. Volume users are able to download the entire data set from DWC.

In December 2010, the Medi-Cal database changed, so that the pricing database field which originally reported the workers' compensation “Dispensed as Written” (DAW or “no substitutions”) price (for a drug for which a cheaper substitute was available) no longer contained this information. The database displayed a “zero” amount for many of the most recent dates of service (the date of service varying with the drug in question). The calculator on DWC’s Web site returned a “zero” base price for those drugs. When DWC became aware of the problem, the Web site calculator was disabled from returning a price. However, the database continued to be downloaded so that those who downloaded the database still received incorrect pricing for many drugs.

Pharmacy providers can use the updated information to re-bill prescriptions for which they were underpaid or not paid during the time that the DWC Web site had inaccurate information for DAW prescriptions.