Bulletin No. 03-04
January 6, 2003

DWC makes Medi-Cal pharmacy fees for workers' compensation prescriptions available via web site

Senate Bill 228 requires that effective January 1, 2004, fees for pharmaceuticals in the workers' compensation system will be based on Medi-Cal prices. DWC has established a web site at which the Medi-Cal price for either simple or compound prescriptions can be obtained. These prices will be updated on a monthly basis. The data is being supplied by the state Department of Health Services Medi-Cal program and will be updated once per month, generally by the Monday following the first weekend of the month.

The division is aware that the file does not contain some products that are typically dispensed directly through a physician's office or clinic. Such prepackaged or repackaged drugs are not part of the Medi-Cal payment because Medi-Cal does not cover drugs dispensed by a doctor's office. Under the Labor Code, direct dispensing is allowed in workers' compensation. Guidance for the pricing of these products will be forthcoming.

The web site is available now for use with January, 2004 data. The web address to obtain the price of a simple prescription is: http://www.dir.ca.gov/dwc/pharmfeesched/pfs.asp. For compound prescriptions, the address is: http://www.dir.ca.gov/dwc/pharmfeesched/pfscompound.asp.

Users will need to enter the eleven digit NDC number, the number of units prescribed, the price billed (including dispensing fee), and the date of service. Users are also asked whether the patient is in a nursing home. For users who have a 10 digit NDC number, two alternate sites have been set up which will allow them to enter the number in segments. For simple prescriptions, go to: http://www.dir.ca.gov/dwc/pharmfeesched/pfsseg.asp. For compound prescriptions, the web address is: http://www.dir.ca.gov/dwc/pharmfeesched/pfscompoundseg.asp.

For those wishing to download the entire data file and record layout, a zipped folder is also available, which contains the data in one file -- http://www.dir.ca.gov/dwc/pharmfeesched/Pharmfeesched.zip and a description of record layout and formulae for establishing prescription pricing in the other -- http://www.dir.ca.gov/dwc/pharmfeesched/PFSInstr.htm. Users are able to download all of the data so that they can enter it into their own systems if they wish.

The service is now operational, but DWC asks users to provide their comments and suggestions for clarifying and improving the product. They will be helpful and appreciated. Comments should be sent to dwcrules@dir.ca.gov. Please put "pharmacy pricing" in the subject line.