Well, for those of us who developed an ulcer or have one in the works, either from this past year or the high Part D cost, here is some good news! Omeprazole, in the 40mg prescription strength, has seen a significant slash in the lowest average wholesale price (AWP) – see Table 1.
Omeprazole is a Proton Pump Inhibitor (PPI) which acts by suppressing gastric acid. Its uses include short-term treatment of active duodenal ulcer; short-term treatment of erosive esophagitis; short-term treatment of active gastric ulcer; short-term treatment of gastroesophageal reflux disease (GERD), Helicobacter pylori eradication to reduce risk of duodenal ulcer recurrence; and long-term pathological hypersecretory conditions. For workers’ compensation claims, it is often used for prevention of nonsteroidal anti-inflammatory drug (NSAID) associated ulceration and NSAID-related ulceration in patients at risk for these conditions. Omeprazole is preferred for use as a first-line medication under Official Disability Guidelines (ODG) criteria.
This considerable reduction in cost would markedly reduce the Part D allocation of the updated Workers Compensation Medicare Set-Aside Arrangement (WCMSA) and potentially facilitate settlement.
As part of best practices, ExamWorks Compliance Solutions continually monitor CMS’ recognized proprietary source, Red Book, for real-time changes for newly generic agents and for average wholesale price (AWP) for medications used to treat the injured worker, as well as PharmD review of all Part D medications for the indication for use for potential exclusion from the WCMSA.
ExamWorks Compliance Solutions strives to provide the most accurate and defensible MSA by utilizing technology and compendia databases which are recognized and supported by the CMS to support inclusion or exclusion of a drug under the Part D benefit. We will continue to monitor changes in medication pricing as well as availability of generic equivalents within the marketplace.
For questions about medications, please contact Nahla D. Rizkallah, PharmD, MSCC, at 678.256.5086 or firstname.lastname@example.org.