As of January 1, 2013, Medicare expanded its Part D guidelines to include coverage for benzodiazepines and barbiturates for certain conditions. For more information on this new expanded coverage, when it will be covered, and how this coverage change is predicted to apply to WCMSAs, please see our prior blog here.
CMS recently issued an alert on their website which provides the date for which this new coverage guideline is to affect WCMSAs: June 1, 2013. Below is the text of the alert:
Effective June 1, 2013, all Workers’ Compensation Medicare Set-Aside (WCMSA) proposals submitted to CMS for a review of the adequacy of the proposal amount are to include the pricing of benzodiazepines and barbiturates, where appropriate.
Please note that WCMSA cases submitted to CMS before June 1, 2013, closed due to missing, incomplete and/or inadequate supporting documentation (or any other reason), and subsequently re-opened after June 1, 2013, will also be subject to a review that includes the pricing of benzodiazepines and barbiturates.
As noted in our prior blog, the silver lining of this change is that the majority of barbiturates and benzodiazepines on the market have generic formulations which are fairly inexpensive. Therefore, if generics are prescribed, the impact of this change should not be significant to WCMSAs.