Notice of Upcoming Enhancement to the WCMSAP

CMS on August 21, 2014
Posted by Jean S. Goldstein, JD, CMSP

CMS posted an alert on the Workers’ Compensation Set-Aside Web Portal (WCMSAP) page indicating a new feature to be available as of October 6, 2014. As of this date, portal users will be able to enter prescription drug information directly into the portal for a specific submission. With this enhancement of the portal, new data entry pages will be added to the WCMSAP, which will enable portal users to indicate if a Claimant is currently taking any prescription medications, or it is anticipated that the Claimant will take any prescription drugs. If prescription drugs are anticipated, drugs can be selected through a lookup feature by searching for the drug name, NDC code, or manufacturer name. Users will then have the option of selecting the drug, adding it to the submission, and entering frequency for the medication, and the number of years based on life expectancy. CMS has also indicated that once the prescription drug information is entered into the new data page, the system will then calculate the prescription drug costs. The alert further indicates that prescription drugs will be priced using the monthly Redbook drug reference that is in effect, at the date of submission.

This forthcoming enhancement begs several questions. Specifically, whether CMS will still require prescription history information dated within six months of the submission, to confirm Claimants’ current or anticipated prescription regimen? While, we have certainly seen less developments for just prescription history information, the question is how or will this change the requirement of providing updated prescription history information with a submission? Will requests for pharmacy printouts from Claimants’ private pharmacies finally be eliminated? Will CMS now consider and apply limited durations of use for medications which portal users are able to enter? Is CMS’ pricing in line with current Redbook pricing, as we have seen numerous inconsistencies in pricing of medications. The CMS notice, which can be found at the link shown below, indicates that an additional alert will be forthcoming with additional information regarding this new enhancement. We are eager to see the results of this new enhancement. (this link will download the document)