The Official Medicare Set Aside Blog And Information Resource

The Opioid Crisis: What is the Government Doing About It?

Opioids, Rx/Pharmacy on August 29, 2018
Posted by Complex Claims Division

There can be little doubt that the opioid crisis has reached staggering levels. The Centers for Disease Control and Prevention (CDC) statistics from 2016 reveal that on average, opioids killed about 115 Americans every day.[1] Drug overdoses have become the leading cause of death in Americans under the age of 50, with opioids accounting for […] Continue

CMS Posts Update of Medicare Part D Opioid Prescribing Mapping Tool

CMS, Medicare Set-Aside Blog, Opioids on April 17, 2018
Posted by Jean S. Goldstein, JD

The Centers for Medicare & Medicaid Services (CMS) released an updated version of the Medicare Part D opioid prescribing mapping tool, providing an interactive, web-based resource that presents geographic comparisons- at the state, county, and ZIP code levels – of Medicare Part D opioid prescribing rates.  The tool allows users to understand and compare opioid […] Continue

CMS Issues Updates for Medicare Advantage and Prescription Drug Benefit Program: Will it Affect Your WCMSA?

CMS, Medicare Advantage, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Opioids on April 5, 2018
Posted by Jean S. Goldstein, JD

Earlier this week, CMS issued a policy change revising the Medicare Advantage Program (MAP) Part C regulations and Prescription Drug Benefit program (Part D).  The ultimate goal of the new policy is to ensure that individual’s treatment needs are met, while improving the quality of care and providing greater choices to MA enrollees.  The full […] Continue

Sublocade – A New Once-Monthly Injection for the Treatment of Opioid Use Disorder

CMS, FDA, Medicare, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Opioids on February 5, 2018
Posted by Katherine Bales, RN, JD

The opioid crisis continues to be one of the most talked about issues facing the health care community, and the nation as a whole, having been declared a national public health emergency. In response, pharmaceutical companies have been actively working on ways to treat the crisis with the development of alternative treatment methods. The FDA […] Continue

Change is Needed: CWCI Study Provides Concrete Evidence of Over Inclusion of Opioids in WCMSAs

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Opioids, Rx/Pharmacy on November 3, 2017
Posted by Jean S. Goldstein, JD

This week, the California Workers’ Compensation Institute (CWCI) released a study documenting opioid use in Workers’ Compensation Medical Set-Asides (WCMSAs).  The study (for which MEDVAL contributed both data and advice concerning MSAs) focused on a specific dataset of CMS approved California WCMSAs from 2015 and 2016, against a control group of claims from 2006 through […] Continue

Endo Pharmaceuticals Voluntarily Withdraws Opana ER From the Market: What Does This Mean For Your Cases?

CMS, Medicare Set-Aside Blog, MSP News, Opioids, Re-Review Process on July 11, 2017
Posted by Erin O'Neill, PA-C, JD

On July 6, 2017, Endo Pharmaceuticals issued a statement indicating it would voluntarily withdraw the opioid pain medication, Opana ER, from the market, in response to the Food and Drug Administration’s request one month earlier. As noted in our prior blog post, the FDA requested that Endo Pharmaceuticals withdraw Opana ER from the market, citing concerns of […] Continue

FDA Requests Endo Pharmaceuticals Withdraw Opana ER From the Market

FDA, Medicare Set-Aside Blog, Opioid, Opioids on June 9, 2017
Posted by Erin O'Neill, PA-C, JD

On June 8, 2017, the Food and Drug Administration (FDA) requested that Endo Pharmaceuticals withdraw Opana ER from the market, citing concerns of ongoing misuse and abuse of the drug. As you will recall from our prior blog post, in March 2017, an FDA advisory committee found that the risks associated with use of Opana ER […] Continue

HHS Grants to Fight Opioid Addiction: How Could the Grants Impact Your MSA?

CMS, Medicare Set-Aside Blog, Opioids, Rx/Pharmacy on May 4, 2017
Posted by Jean S. Goldstein, JD

Nationwide, states and workers’ compensation boards have been taking measures to curb the overprescribing and misuse of opioids and the crisis that has ensued as a result.  Nonetheless, opioid addiction continues to be a growing concern.  In an effort to help states combat the opioid epidemic, the U.S. Department of Health and Human Services (HHS) […] Continue