Through a recent alert issued on August 19, 2014, CMS has announced that it will be providing a mechanism for users of the Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) to enter prescription drug information and calculate the proposed prescription drug portion of the WCMSA proposal. The alert states that this will be available on all new and existing “work-in-progress” cases as of October 6, 2014. To access the alert, please click here.
A lookup tool will be provided to select the proper drug. Additionally, the tool will provide pricing and the prescription allocation will be automatically calculated once proper frequency is entered.
The alert provides that the new tool will include the following features:
- New data-entry pages to provide users with the ability to indicate
if a claimant is taking, or expecting to take prescription drugs as a
result of the workers’ compensation injury.
- Look-up tool that allows the user to search by drug name, National
Drug Code (NDC) or manufacturer name.
- Ability for user to select drug from look-up tool and add it to the
- Ability for user to enter frequency for anticipated medications
(per day, week or month) and system will calculate expected drug costs.
Helios Settlement Solutions applauds this action by CMS and believes that the new functionality will be very useful; submitters of WCMSAs through the WCMSAP will be assured of proper pricing of prescription drugs based upon monthly Redbook Drug Reference pricing in effect when the submission is sent in for review. This should alleviate a great deal of prescription drug pricing discrepancies that have typically occurred in the past.
It is unclear from this alert if submitters can use the tool to check pricing before the case is created/submitted. If submitters are able to do this, once the MSA is first prepared, the submitter could be informed of any possible changes in pricing. The alert does not clearly indicate if this will be possible or part of the functionality. CMS did announce in its alert that more information will be forthcoming prior to the October 6, 2014 implementation and Helios is hopeful that CMS will offer that this functionality will be part of the new process.