Prescription medication updates that may affect your Medicare Set Aside

We continually monitor RED BOOK® Average Wholesale Price (AWP) of the most common medications seen in Workers’ Compensation Medicare Set-Aides (WCMSA) in order to identify pricing changes affecting MSAs positively. The month of September brought additional price drops for the medication quetiapine fumarate (Seroquel®), in 100mg and 300mg tablets, commonly prescribed to treat bi-polar disorder.

Below are the products we have identified with a reduced AWP and confirmed in the Centers for Medicare and Medicaid Services (CMS) WCMSA portal.

Product name

NDC Code

Dosage form

Strength

AWP unit price reduction

Quetiapine Fumarate

00904-6640-61

TAB

100 mg

$5.89

Quetiapine Fumarate

00904-6642-61

TAB

300 mg

$9.60

Please note that RED BOOK AWP is subject to change and this pricing is subject to an increase or decrease in the future.

CMS will utilize the lowest AWP when reviewing a WCMSA, therefore the lower pricing of these medications will immediately impact the prescription costs for WCMSAs (both present as well as prior WCMSA’s that have not settled and there is no CMS determination issued) where these drugs are prescribed.

It is our recommendation carriers, TPAs and claim handlers review cases where the above noted medications are prescribed to determine the benefit from decreased cost. We will proactively reach out to our clients in reference to previously completed WCMSA’s where these medications were prescribed and continue to monitor future AWP changes and generic equivalents introduced to the market in order to keep the industry informed.

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