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.
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 email@example.com.