A CWCI study finds that most injured worker prescriptions in California are in the Medi-Cal fee schedule database that sets maximum reasonable pharmacy fees and helps control workers’ comp costs, suggesting that other factors such as an increase in the number of scripts/claim, increases in Average Wholesale Prices used to calculate pharmacy fees, a shift toward more expensive drugs, and PBM contract rates and payments that exceed fee schedule allowances, may be responsible for recent growth in prescription drug costs.
Percentage of Calif. WC Prescriptions Falling Outside the Medi-Cal Fee Schedule Database
