1. (a) For a pharmaceutical dispensed through a mail order pharmacy, the provisions of this article apply to determine maximum drug ingredient cost, dispensing, compounding and sterility fees for pharmaceuticals dispensed to an injured worker for treatment of a California workers' compensation injury or illness, whether the injured worker resides within the state of California or outside of the state of California.
2. (b) The cost of shipping and handling of pharmaceuticals is included in reimbursement for the drug ingredient and is not separately payable.
3. (c) Unless otherwise specified in this article, for a pharmacy-dispensed drug that is not set forth in the Pharmaceutical Fee Data File, and not otherwise covered by, or bundled into, a fee schedule payment for facility or physician services, the maximum reasonable drug ingredient fee shall not exceed the Wholesale Acquisition Cost applicable to the National Drug Code.

Note: Authority cited: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 4603.2 and 5307.1, Labor Code.

History

1. New section filed 12-11-2024; operative 7-1-2025. Submitted to OAL for filing and printing only pursuant to Government Code section 11340.9(g) (Register 2024, No. 50).