As part of our best business practices, we continually monitor RED BOOK®Average Wholesale Price (AWP) of the most common medications present in Workers’ Compensation Medicare Set-Aside (WCMSA) arrangements. This practice assists in identifying price changes positively affecting WCMSAs.
The month of February brought price drops of the following medications:
- buprenorphine/naloxone (Suboxone®) commonly prescribed for opioid dependence
- diclofenac (Voltaren®) in multiple strengths used to treat pain
- methadone (Dolophine®) commonly prescribed for detoxification or pain management
- bupropion (Wellbutrin®) in multiple strengths prescribed for depression
- clonazepam (Klonopin®) used for anxiety or panic disorders
- quetiapine (Seroquel®) commonly used to treat bipolar disorder, depression or schizophrenia
- tramadol (Ultram®) used to treat pain
The products in the following table have a reduced AWP, confirmed in the Centers for Medicare and Medicaid Services (CMS) WCMSA portal.
|
Product Name |
NDC Code |
Dosage Form |
Strength |
AWP Unit Price Reduction |
| Bupropion Hydrochloride |
00781-5528-31 |
TER |
150 mg |
$3.92 |
| Bupropion Hydrochloride |
00781-5529-31 |
TER |
300 mg |
$2.24 |
| Diclofenac Sodium |
61145-0102-12 |
ECT |
75 mg |
$0.51 |
| Buprenorphine Hydrochloride/Naloxone Hydrochloride |
00406-8020-03 |
SL TAB |
8/2 mg |
$0.34 |
| Clonazepam |
00781-8018-05 |
TAB |
0.5 mg |
$0.11 |
| Diclofenac Sodium |
61145-0101-18 |
ECT |
50 mg |
$0.10 |
| Quetiapine Fumarate |
00904-6639-61 |
TAB |
50 mg |
$0.09 |
| Tramadol Hydrochloride |
68094-0017-61 |
TAB |
50 mg |
$0.06 |
| Methadone Hydrochloride |
66689-0898-40 |
TBS |
40 mg |
$0.04 |
Please note that RED BOOK AWP is subject to change and this pricing is subject to an increase or decrease in the future.
CMS uses the lowest AWP when reviewing a WCMSA. The lower price of these medications will immediately affect the prescription costs for WCMSAs (both present as well as prior WCMSA’s that have not settled and there is no CMS determination issued). We will contact our clients in reference to previously completed WCMSA’s where these medications have been prescribed. It is our recommendation that carriers, TPAs and claim handlers review cases to determine the benefit from decreased cost of these medications.
Optum will continue to keep the industry informed of changes in AWP pricing, in addition to when generic equivalents enter the market.