Workers' compensation pharmacy fee schedule - Compound prescription

NOTICE: The February 20, 2019 data file will remain in effect until the DWC has adopted updates to the Pharmaceutical Fee Schedule that are necessary in light of changes in the Medi-Cal Pharmacy Fee Schedule payment methodology. DWC will be holding a public hearing and accepting public comment on the fee schedule revisions. Weekly updates to the data file will resume after the revised fee schedule methodology is adopted. Notices relating to the Pharmaceutical Fee Schedule rulemaking action will be sent to the DWC Newsline mailing list. You may subscribe to the DWC Newsline mailing list on the DIR subscription web page.

This data is provided as a service to the workers' compensation community. Please send comments or questions to DWCFeeSchedule@dir.ca.gov.

You may download the Medi-Cal pharmacy fee rates here (Zip file, 6.40 MB, updated 03/08/2019 - also available via ftp to www.dir.ca.gov, anonymous login). The file's record layout and instructions are included in the zip file, and may also be viewed here.

You may look up the current price of Compound prescriptions by completing the form below and clicking "price". For simple prescription pricing, click here. If you are working from a file with 10 digit NDC numbers, please click here.

Enter total count of separate ingredients in compound prescription, then click continue:

Count:

Workers' compensation pharmaceutical fee schedule — Physician dispensed pharmaceuticals

Legislation that became effective on January 1, 2012 places new caps on fees for pharmaceuticals dispensed by physicians. These new caps are contained in Labor Code section 5307.1.

Fee File Posting Interruption between 01/15/14 and 03/26/2014

Note that there was an interruption in posting the weekly files. After the posting of the 01/15/2014 file, the next file posted was dated 03/26/2014. The file posted 03/26/2014 has substantially fewer NDCs than the 01/15/2014 file. We have confirmed with the California Department of Health Care Services that many NDCs were removed from the Medi-Cal file; some were removed as the products are no longer manufactured, others were removed because Medi-Cal no longer pays for the product. This may unfortunately result in a lack of a workers’ compensation fee schedule price for some NDCs.

Updated pharmaceutical price files posted / list of NDCs with price updates for the period September 1, 2011 to March 14, 2012 posted

Due to a delay in the availability of updated Medi-Cal pharmaceutical price data beginning in September of 2011, the Division was unable to post updated pharmaceutical fees for many months. Beginning with the April 11, 2012 data file, the Division of Workers' Compensation resumed posting weekly price data files for download and for use in the price calculator. The Department of Health Care Services has indicated that beginning May 23, 2012 the weekly pharmaceutical fee data file sent to the Division includes all national drug code (NDC) price updates during the period Sept. 1, 2011 to March 14, 2012 that were missing due to the temporary unavailability of First Data Bank average wholesale price (AWP).

DWC has posted an Excel Workbook which lists NDCs that were new (sheet one), or that had pricing changes (sheet two), that took effect during the period of September 1, 2011 through March 14, 2012. Beginning May 23, 2012, the weekly pharmaceutical fee schedule data file and price calculators on the DWC website include all of the updates. DWC suggests that workers' compensation providers examine the NDC list and, if warranted, resubmit pharmaceutical bills that were affected by the unavailability of price updates, and recommends that payers issue payments as appropriate. Payers and providers may consider whether there are contracts in place that may impact the need to re-process bills and issue corrected payments.

For notifications regarding the delay and the resumption of weekly price files please see the DWC Newslines:
DWC newsline 33-12.
DWC newsline 17-12.
DWC newsline 56-11.
DWC newsline 42-11.