Pharmacy fee schedule - prescriptions dispensed on or after July 1, 2025
NOTICE: The pharmaceutical fee schedule is revised for dates of service on or after July 1, 2025. Updated Pharmaceutical Fee Data Files and National Provider Identifier Files will be posted on a weekly basis beginning shortly before the July 1, 2025, effective date. The new fee schedule implements a revised pricing methodology based upon Medi-Cal changes and implements provisions of Labor Code section 5307.1 related to physician dispensing of pharmaceuticals. You may review details of the revisions on the DWC Approved Regulations webpage. To assist the public, sample data files are being provided to allow programming of business systems used for pharmaceutical billing or bill review and payment. A new Pharmaceutical Fee Calculator will be provided as a service for the public. Notices relating to the pharmaceutical fee schedule will be sent to the DWC Newsline mailing list. You may subscribe to the DWC Newsline mailing list on the DIR subscription web page.
Please send comments or questions to DWCFeeSchedule@dir.ca.gov.
Pharmaceutical Fee Schedule Calculators Prescriptions on or after July 1, 2025
Pharmaceutical Fee Schedule and National Provider Identifier data files for new fee schedule
- PFS Data Files - file at https://www.dir.ca.gov/ftproot/PFSandNPI.zip
Note: that the production files are not made available separately, but as a single compressed file.
Resources
- Labor Code section 5307.1
- Regulation Text
- California DWC Medical Billing and Payment Guide
- California DWC Electronic Medical Billing and Payment Companion Guide
- California Board of Pharmacy - Pharmacy Law Book
- Business & Professions Code § 4170 – Prescriber Dispensing
- FDA National Drug Code Directory – Finished Drug Product Database / Unfinished Drug Database
- FDA Orange Book – Approved Drug Products with Therapeutic Equivalence Evaluations
- FDA Purple Book – Database of Licensed Biological Products
- National Plan & Provider Enumeration System – National Provider Identifier search tool
- NDC 10 to NDC 11 Conversion Chart
July 2025