Newsline No. 17-12  
April 13, 2012  

Division of Workers' Compensation posts updated pharmaceutical fee schedule data file and provides information regarding paper pharmaceutical billing form

The Division of Workers’ Compensation (DWC) has posted an updated pharmaceutical fee schedule price calculator and data file on its website, including the most recent prices received from the Department of Health Care Services (DHCS). The division will resume posting the weekly files as they are received from DHCS.

DHCS has indicated that there may be further Medi-Cal price updates for some national drug codes (NDCs) in the coming weeks as it works to restore price dates that were missing due to the unavailability of First Data Bank average wholesale price (AWP) data that began in September 2011. When the DHCS has completed the update that was necessitated by the unavailability of First Data Bank AWP, DWC will prepare a listing of those NDCs that experienced changes; workers’ compensation payers may then make corrected payments for pharmaceutical bills that were paid during the period that updated fees were not available. DHCS has indicated that the updates should be complete within a few weeks.

DWC has received inquiries regarding the paper billing form adopted for pharmacy billing. The billing regulation adopts the National Council on Prescription Drug Programs (NCPDP) Workers’ Compensation/Property & Casualty Universal Claim Form and specifies version 1.0 – 05/2008. However, the NCPDP has informed the division that version 1.0 was a draft that was never put into production. The NCPDP form that is available is version 1.1 – 05/2009. DWC intends to revise the regulations to specify the correct version number for the form. In the meantime, it would appear to be reasonable for pharmacies to use version 1.1 and for claims administrators to process bills submitted on that form.