The Official Medicare Set Aside Blog And Information Resource

CMS Issues Final Rule for Medicare Advantage and Part D Pricing

CMS, Medicare Advantage, Rx/Pharmacy on May 22, 2019
Posted by Jean S. Goldstein, JD

Last week, the Centers for Medicare and Medicaid Services (CMS) issued a final rule, (CMS-4180-F) impacting Medicare Advantage Plans (MAP) and Part D programs.  The rule aims to ensure that patients have greater transparency into the cost of prescription drugs, so that beneficiaries can compare options and also enables MAPs to negotiate better prices for […] Continue

A Reversal of the Opioid Trend in California

Medicare Set-Asides, Opioids, Rx/Pharmacy on May 15, 2019
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

In February, the California Workers’ Compensation Institute (CWCI) published a report that had some interesting findings regarding the use of prescription drugs. With respect to utilization, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen now rank above opioids as the most commonly prescribed medication class for workers’ compensation claimants. In terms of reimbursement, CWCI […] Continue

FDA Grants Approval for Generic Narcan (naloxone HCL) Nasal Spray

FDA, Opioids, Rx/Pharmacy on May 6, 2019
Posted by Jean S. Goldstein, JD

Recently, the FDA approved the first generic Narcan nasal spray to treat opioid overdose.  Narcan temporarily reverses the effects of opioid analgesics and is essentially an antidote for opioid overdose.  While generics of the injectable version of this medication, Evzio, have been available for quite some time, a generic of the nasal spray has not.  […] Continue

2019 Social Security and Medicare Trustees’ Reports Issued; Reports Sound Alarm (Again) as Depletion of Trust Fund is Imminent

Medicare, MSP News, Social Security on May 2, 2019
Posted by Jean S. Goldstein, JD

Each year, the board of trustees of the Social Security Trust Fund and Medicare Trust Fund release reports to Congress providing an estimated projected financial outlook for the programs.  Last week both reports were released.  The 79th annual Social Security Report can be found here, and the 54th annual Medicare report can be found here.  […] Continue

Gabapentin Abuse on the Rise

FDA, MSAs, Rx/Pharmacy on April 25, 2019
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

All of the focus on the opioid crisis may have overshadowed a growing trend of abuse and misuse for another drug that’s well known to those of us in the workers’ compensation industry . . . gabapentin. Ironically, the growing trend of gabapentin abuse is related to the opioid crisis. In an effort to adhere […] Continue