Official Medical Fee Schedule (OMFS)
Pharmaceuticals Fee Schedule

§ 9789.40 Pharmacy

Last update
September 30, 2023


The Department of Workers’ Compensation maintains the Official Medical Fee Schedule (OMFS), which consists of seven separate parts. Each of the seven parts of the OMFS have a fee schedule and associated billing requirements.

For Pharmaceuticals, Section 9789.40 of the Pharmacy Regulation provides explicit instructions for calculating reimbursements: “The maximum reasonable fee for pharmaceuticals and pharmacy services rendered after January 1, 2004 is 100 percent of the fee reimbursement prescribed in the relevant Medi-Cal payment system, including the Medi-Cal professional fee for dispensing.”

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To determine the correct reimbursement for physician-dispensed pharmaceuticals for dates of service as of the most recent Wednesday, use the DWC calculator: Workers’ Compensation pharmacy fee schedule - Simple prescription. Every Wednesday afternoon, the DWC updates and replaces the reimbursements listed in the pharmacy fee schedule.

The Pharmacy fee schedule amount is 100% of the Medi-Cal rate PLUS the dispensing fee of $7.25. The dispensing fee is required per NDC number for each separate date of service. The $7.25 dispensing fee is per dispensed drug; NOT per dispensed bottle of pills.

For more information, refer to the regulations linked below.

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California Workers’ Comp Regulations

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