Significant Price Changes for Meloxicam & Benefits to Your WCMSAs

Medicare Set-Aside Blog, MSAs, Rx/Pharmacy on April 2, 2020
Posted by Jean S. Goldstein, JD, CMSP

Mobic (meloxicam) is a nonsteroidal anti-inflammatory drug (NSAID) commonly seen in workers’ compensation claims.  It is most frequently prescribed to treat osteoarthritis (OA) starting at doses of 7.5 mg and may be increased to 15 mg daily to reduce pain, joint swelling, and stiffness in joints. Recently, the average wholesale price of this medication dropped significantly as noted in the table below:

Dosage Previous Pricing (AWP)Current Pricing (AWP)
7.5 mg $2.75 $0.05
15 mg $4.25 $0.05

Starting today, the current pricing of $0.05 is now available in CMS’ maintained Workers’ Compensation Medicare Set-Aside (WCMSA) Portal. This means that for any WCMSA submitted for CMS’ review and approval the new pricing should be applied. This is great news for cases that are in line for submission to CMS.  Also, this lower pricing presents an opportunity to reduce the cost of a previously prepared WCMSA that not been submitted to CMS for review and is still being prepared for settlement negotiations.  It is always beneficial to have updated treatment and medication costs reflected in a WCMSA before settlement negotiations. 

This is also a good reminder to review any files that have been submitted to CMS, but not yet settled.  Those cases may be ripe for an Amended Review.  While a decrease in medication price alone does not meet the Amended Review criteria, there may be other medical or prescription medication regimen changes that may meet the criteria.  As a reminder, the Amended Review process allows for a second review of a case with new information since the previous submission.  However, to utilize the amended review process cases must meet the following requirements:

  • CMS has issued a conditional approval within at least 12, but no more than 72 months prior;
  • A prior Amended Review has not been submitted;
  • The case has not yet settled as of the date of the request for amended review; and
  • Projected care has changed so much that the submitter’s new proposed amount would result in a 10% or $10,000 change (whichever is greater) in CMS’ previously approved amount.

We will continue to monitor the application of the new pricing in cases submitted for review and approval, and report any discrepancies.  If you would like to discuss this medication price change or the possibility of an Amended Review, please contact us at info@medval.com.