Part D Prescription Drug Coverage and Workmans’ Compensation Medicare Set-Aside Arrangements

Medicare Set-Aside Blog on December 30, 2005
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Centers for Medicare and Medicaid Services released an important memo today. As of January 1, 2006, Medicare will be  including Part D prescription drug coverage  and this new policy meant MSAs would require projections about future Medicare-covered medications related to the work injury.

As with all MSAs, the prescription drug inclusions must be intended to protect Medicare’s interests. CMS indicated prescription drugs must be calculated separately from future medical treatment and must include the method of calculation.

Some of the questions and answers discussed in this memo include:

What happens if a WCMSA proposal received on or after January 1, 2006, does not include an amount for future prescription drug treatment?

Should funds for future prescription drug treatment be included in the calculation of the total settlement amount to determine if the WCMSA proposal should be reviewed by CMS?

Do claimants have to resubmit their WCMSA proposals if CMS already issued a written opinion as to the total WCMSA amount?


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