The Official Medicare Set Aside Blog And Information Resource

Does Orphan Drug Status for Rofecoxib Open the Door for Increased Use?

Medicare Set-Aside Blog, Rx/Pharmacy on December 13, 2019
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

Just over two years ago, the FDA granted orphan drug status to rofecoxib for the treatment of hemophilic arthropathy. Rofecoxib was previously marketed by Merck under the trade name of Vioxx and depending on your age, you may recall hearing about Vioxx in the news. Vioxx was initially approved by the FDA in 1999 for […] Continue

CMS to Host Town Hall Meetings to Discuss Medicare Secondary Payer Recovery Topics

CMS, Conditional Payments, Medicare Set-Aside Blog, MSP News on December 5, 2019
Posted by Jean S. Goldstein, JD, CMSP

The Centers for Medicare & Medicaid Services issued an alert today that it will be hosting two town hall meetings to discuss common Commercial Repayment Center (CRC) Non-Group Health Plan (NGHP) Ongoing Responsibility for Medicals (ORM) and Group Health Plan (GHP) recovery topics. The first town hall will be held on January 14, 2020 at 1:00 […] Continue

My Prescription Costs . . . How Much??

Medicare Set-Aside Blog, Rx/Pharmacy on December 2, 2019
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

In recent years, a great deal of attention has been paid to the topic of drug prices and more specifically, how to control them. On a personal note, it’s likely that most of us have gone to the pharmacy to pick up a prescription and been surprised by the cost. On a professional note, in […] Continue

CMS Will Maintain $750 Recovery Threshold for 2020

Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP News on November 27, 2019
Posted by Jean S. Goldstein, JD, CMSP

The Medicare Secondary Payer (MSP) provisions of the Social Security Act prohibit Medicare from making payment where payment has been made or can reasonably be expected to be made by a primary plan.  If payment has not been made, or cannot reasonably be expected to be made promptly by the plan, Medicare may pay for […] Continue

Baltimore-Based Law Firm Repays U.S. Over 90K in Conditional Payments

Medicare Set-Aside Blog, MSP News on November 25, 2019
Posted by Jean S. Goldstein, JD, CMSP

Earlier this month, in a press release, the United States Attorney for the District of Maryland Robert K. Hur announced that a Baltimore-based law firm has paid the United States $91,406.98 to resolve allegations that it failed to reimburse Medicare for conditional payments that had been made to medical providers on behalf of firm clients.  […] Continue