CMS Updates WCMSA Reference Guide: New Policy on EBMSAs

Yesterday, CMS released an updated Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide.  Version 3.5 of the guide contains two new sections and no other changes.  The additional sections relate to evidence-based on non-submit Medicare Set-Asides and the pre-requisite steps prior to submitting a workers’ compensation settlement for review. ECS has evaluated the additional sections and… Read more »

A Comprehensive View of the Amended Review Process

Recap of Amended Review: It has been four years since CMS introduced its Amended Review process on July 10, 2017. By way of background, Amended Review finally afforded the parties with an opportunity for a second bite of the apple following the issuance of a CMS decision. Qualifying cases for Amended Review must provide a… Read more »

Summer Pharmacy Happenings!

Summer has brought in some changes in the pharmacy realm offering us additional potential to mitigate claims! The lowest Average Wholesale Price has been impacted by drugs which went generic, seen price drops and newly available to the market.  Drugs that went generic: Duexis® (ibuprofen/famotidine) 800mg-26.6mg tablet – $33.09 to $11.08 for the generic; 66.5%… Read more »

Ask Annie: MSAs and the “You Break It, You Buy It” Policy

Question: We are trying to settle a workers’ compensation claim with a Medicare beneficiary for $50,000. The claimant sustained an admitted right shoulder injury. He has unrelated neck issues from an old car accident. He and his treater are trying to argue the shoulder injury exacerbated his preexisting neck condition. We have denied the neck… Read more »

MSA Risk and Reward: Examining “Non-Threshold” Settlements

Here is a sneak peek into this week’s webinar topic. Register here if you haven’t already. First, what is a “Threshold” Settlement?   Let’s examine the guidance set forth by Medicare in its Workers’ Compensation Medicare Set-Aside Allocation (WCMSA) Reference Guide. Medicare outlines its workload review criteria in Section 8.1 and indicates it will review a… Read more »

Sertraline (Zoloft®) Price Cut

With the start of a new year, we typically see price hikes but that is not the case with sertraline (Zoloft®) where we have seen a significant price cut. Sertraline, a selective serotonin reuptake inhibitor (SSRI), is FDA approved for major depressive disorder (MDD), obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder… Read more »

Another Price Drop for Celecoxib (Celebrex®)

Celecoxib (Celebrex®), the only available cyclooxygenase-2a (COX-2) in the United States, has had a price drop this month in the 200mg capsule formulation. Celecoxib is FDA indicated to treat signs and symptoms of osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis and ankylosing spondylitis. It is also indicated to manage acute pain and to treat primary dysmenorrhea.… Read more »

Aripiprazole (Abilify®) Price Drop

Abilify® (aripiprazole), a second generation atypical antipsychotic, has been a high cost medication until a recent and dramatic reduction in price. Aripiprazole is FDA approved for schizophrenia and acute mania, and as an adjunct second-line therapy for bipolar maintenance and major depressive disorder. It also has non-FDA medically accepted uses of borderline personality disorder and… Read more »