Price Slash on a Commonly Seen MSA Drug — Omeprazole

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.

Table 1

Previous AWP

Current AWP

Percent change

$6.68

$0.14

97.90%

 

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 nahla.rizkallah@examworkscompliance.com.

Nahla Rizkallah, PharmD, MSCC

Nahla Rizkallah, PharmD, MSCC

Nahla D. Rizkallah, PharmD, MSCC, serves as the Senior Clinical Pharmacist at ExamWorks Compliance Solutions. In this capacity, she performs prescription analysis to optimize drug therapy using evidence-based guidelines and national guidelines, and participates in physician outreaches to implement the recommendations. She has 29 years of experience in various area of pharmacy practice including: review of Part D medications on Medicare Set-Aside Allocations, prior authorization reviews for the Florida Medicaid program as Senior Clinical Pharmacist, development of drug utilization criteria, academic detailing, Pharmacy and Therapeutics Committee, Pharmacy Manager for a closed mental health facility, Pharmacy Manager for the indigent, staff/clinical pharmacist for assisted- living facilities (ALFs), medication audits for ALFs, drug information center, clinical pathways, staff education, and surgical/medical pharmacy satellite at All Children’s Hospital. Dr. Rizkallah has the following certifications: Medicare Set-Aside Certified Consultant, Hypertension and Dyslipidemias, and Diabetes. Dr. Rizkallah received her Doctorate from the University of Florida in Gainesville followed by a one year American Society of Health-System Pharmacists accredited residency.

For questions about medications or the ExamWorks Compliance Solutions Pharmacy programs, please contact Nahla D. Rizkallah, PharmD at 678.256.5086 or nahla.rizkallah@examworkscompliance.com

Don't miss out!
Subscribe for Blog Updates
We promise not to spam you. Unsubscribe at any time.
Invalid email address