The Official Medicare Set Aside Blog And Information Resource

FDA Requires Stronger Warnings for Benzodiazepines   

FDA, Medicare Set-Aside Blog on October 22, 2020
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

On September 23, 2020, the FDA Drug Safety Commission announced that manufacturers of benzodiazepines will be required to update the boxed warning within the prescribing information for these products. Benzodiazepines, a group of medications that includes Ativan (lorazepam), Xanax (alprazolam) and others, are commonly used to treat anxiety disorders, panic disorder, insomnia, certain types of […] Continue

Section 111 NGHP User Guide Version 6.0: What is Included in a TPOC?

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog on October 16, 2020
Posted by Jessica M. Wingenroth, JD

Earlier this month the Centers for Medicare and Medicaid Services (CMS) released updated policy guidance surrounding the calculation of Total Payment Obligation to Claimant (TPOC) amounts, required to be reported by Responsible Reporting Entities (RREs) via Section 111, Mandatory Insurer Reporting. A TPOC is defined as a settlement, judgment, award or other payment that is […] Continue

MSA PEARLS: THE AMENDED REVIEW PROCESS

CMS, Medicare Set-Aside Blog, WCRC on October 14, 2020
Posted by Noel D. Sturtz, Client Program Manager

An Amended Review success for our client: Their initial CMS-approved MSA included lumbar surgery and a spinal cord stimulator, both of which we had allocated based on the records reviewed. Per the additional records for the Amended Review, the claimant subsequently underwent lumbar fusion, with significant improvement such that the treating physician ultimately concluded that […] Continue

FDA Approves New Indication for Spravato (Esketamine) Nasal Spray

FDA, Medicare Set-Aside Blog on October 9, 2020
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

Last month, the FDA approved a new indication for Spravato (esketamine) nasal spray. Spravato, in combination with an oral antidepressant, is now approved to treat adults with major depressive disorder (MDD) who are experiencing suicidal thoughts or ideation. In granting approval for the new indication, the FDA relied on the results of two phase III […] Continue

Updated WCMSA Reference Guide Issued with Newly Added Appendix 7: Major Medical Centers by State, National Provider Identifier and Zip Code

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, WCRC on October 6, 2020
Posted by Noel D. Sturtz, Client Program Manager

On October 5, 2020, the Centers for Medicare & Medicaid Services (CMS) released a revised Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide. The updated Guide is version 3.2. As with other versions, a summary of updates to the Guide is found in Section 1.1, and consists of the following changes: The major medical centers […] Continue