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.
CMS recently issued a Memorandum dated May 11, 2011 confirming there are no statutory or regulatory provisions requiring a WCMSA be submitted to CMS for review. Submission of a WCMSA proposal to CMS for review and approval is a voluntary process which is recommended by CMS, but not required. This statement in writing by CMS … Read moreCMS Issues Memorandum Reiterating WCMSA Voluntary Review Thresholds