The Official Medicare Set Aside Blog And Information Resource

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 Issues Education Regarding Concurrent Use of Opioids and Benzodiazepines

CMS, Opioids, Rx/Pharmacy on September 24, 2019
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

On July 1st, CMS issued a Medicare Learning Network (MLN) article regarding the potential dangers associated with the concurrent use of opioids and benzodiazepines. This combination of drugs has always been prescribed cautiously in light of the depressive effect that both drugs can have on a patient’s ability to breathe. When used together, the resulting […] Continue

Submitting a WCMSA with Lyrica to CMS for Approval? Generic Lyrica (pregabalin) Now Available in CMS’ WCMSA Portal

CMS, Rx/Pharmacy on August 2, 2019
Posted by Jean S. Goldstein, JD

You may recall our blog from last week announcing the long awaited FDA approval of generic versions of the drug, Lyrica (pregabalin).  While the FDA’s announcement sparked joy among all in the workers’ compensation industry, it was not until today that pregabalin became available for pricing and allocation in CMS’ maintained Workers’ Compensation Medicare Set-Aside […] 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

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