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% reduction in cost.

Duexis®, a combination of a nonsteroidal anti-inflammatory drug (NSAID) and antiulcer agent, is infrequently utilized in the Workers’ Compensation (WC) scope. Both constituents are available over-the-counter and prescription formulations at markedly reduced cost. The Official Disability Guidelines (ODG) state ‘with less benefit and higher cost, using Duexis® as first-line therapy is not justified.’       

Chantix® (varenicline) 0.5mg and 1mg – $9.76 to $9.27 for the generic; 5% reduction in cost.

Chantix®, for smoking cessation assistance, may not be seen in the Workers Compensation Medicare Set-Aside Arrangement (WCMSA); however, smoking is a significant comorbidity and cessation may improve health outcomes in chronic pain patients.

Drugs which saw price drops:

All prescription strengths of ibuprofen: NSAID:

Ibuprofen 400mg tablet – from $0.15 to $0.04; ~73.4% reduction in cost.

Ibuprofen 600mg tablet – from $0.22 to $0.04; ~82% reduction in cost.

Ibuprofen 800mg tablet – from $0.14 to $0.06; ~57% reduction in cost.

Duloxetine 30mg capsule – from $1.92 to $1.72; ~10.5% reduction in cost.

New drug:

Kloxxado® (naloxone) 8mg/0.1ml nasal spray – $150 per package of two.

Kloxxado® provides double the dose of Narcan® 4mg/0.1ml nasal spray, offering a significant tool addition to the arsenal of reversal of opioid overdose. A happy surprise is that it is priced the same as the lower dose formulation, 4mg/0.1ml nasal spray!

Reduction in cost of medications obviously reduces the Part D allocation of the updated WCMSA and potentially facilitates 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, 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

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