The California Division of Workers’ Compensation (DWC) adopted long-awaited Pharmaceutical Fee Schedule rules, introducing major changes to pharmaceutical billing and reimbursement.

Key updates include:

• Replacing AWP with a new pricing benchmark
• A two-tiered dispensing fee structure based on pharmacy transaction volume
• Introducing weekly data files to determine pricing fees and identify pharmacies eligible for higher dispensing fees
• Establishing reimbursement guidelines for physician-dispensed medications, compounded drugs, and repacks

To assist stakeholders, the DWC launched a new website with information about the new Pharmaceutical Fee Schedule. It includes sample data files to help with programming business systems used for billing, bill review, and payment. Additional sample files and a new Pharmaceutical Fee Calculator will also be available for stakeholder testing in the first quarter of 2025.

These rules go into effect July 1, 2025.