The Official Medicare Set Aside Blog And Information Resource

CMS Issues Revised Self-Administration Toolkit for WCMSAs, Version 1.3

CMS, Medicare Set-Asides, Professional Administration on October 18, 2019
Posted by Jean S. Goldstein, JD

The Centers for Medicare & Medicaid Services (CMS) issued a revised Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside (WCMSA) Arrangements, version 1.3 yesterday. The purpose of this toolkit is to describe the WCMSA self-administration process and provide guidelines for claimants who are administering their own WCMSA.  Specifically, the toolkit: Describes the self-administration process, from when […] Continue

Behind the Counter Availability of Naloxone

Medicare Set-Asides, Opioids, Rx/Pharmacy on October 2, 2019
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

One component of the FDA’s drug approval process is a designation of the drug as prescription only or over-the-counter (OTC). If a drug is initially approved as a prescription only medication, this doesn’t mean that the drug cannot later be approved for over-the-counter status. In order to facilitate this change, the drug manufacturer files a […] Continue

CMS to Begin Utilizing 2016 Life Table

CMS, Medicare Set-Asides, WCRC on September 13, 2019
Posted by Jean S. Goldstein, JD

Starting October 12, the Centers for Medicare and Medicaid Services (CMS) will begin using the CDC’s “Table 1: Life Table for the total population: United States, 2016” for Workers’ Compensation Medicare Set Aside (WCMSA) life expectancy calculations.  This means that for any WCMSA proposal received by CMS through the voluntary review program, or where any […] Continue

U.S. House of Representatives Introduce Workers’ Compensation Medicare Set-Aside Legislation

CMS, Medicare Set-Asides, MSP News on August 23, 2019
Posted by Jean S. Goldstein, JD

You may recall that in 2018 we reported that a Senate Bill was introduced, “[t]o amend title XVIII of the Social Security Act to provide for the application of Medicare secondary payer rules to certain workers’ compensation settlement agreements and qualified Medicare set-aside provisions.”  As we described it, the Bill was a piece of legislation to […] Continue

FDA Approves Generic Versions of Lyrica

FDA, Medicare Set-Asides, Rx/Pharmacy on July 24, 2019
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

On Monday, the FDA issued a press release announcing the approval of generic versions of the drug Lyrica (pregabalin). Those of us operating in the workers compensation industry are all too familiar with Lyrica. It’s a high-priced medication utilized for the treatment of pain related to nerve damage, and its inclusion within Workers’ Compensation Medicare […] Continue