On September 20, 2010, PMSI Settlement Solutions met with CMS to continue our dialogue around the pharmacy portion of MSA allocations. Our main focus during this meeting was to address inconsistencies we are all experiencing in the interpretation of the May 14, 2010 Memorandum regarding Part D covered prescription drugs. PMSI addressed inconsistencies concerning off-label prescription drug usage, the appropriate treatment duration for acute drugs, and the re-review process. For example, we highlighted inconsistencies across reviewers at the Workers’ Compensation Review Center (WCRC) regarding the exclusion of drugs like Lyrica, Gabapentin and Lidoderm. PMSI also requested that CMS issue a formal directive in regards to which compendia will be utilized during the review process. We highlighted the need for policies and procedures that would support the various policy memos.
The below statement regarding WCMSAs was included in the financial report issued by Centers for Medicare and Medicaid Services’ (CMS) for fiscal year 2010 wherein they document an increase in the amount of approved WCMAs in the first 11 months of fiscal year 2010 due to CMS pricing of prescription drugs. However, it is anticipated … Read moreCMS Issues Financial Report for Fiscal Year 2010 Addressing WCMSAs