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MSA article about Prescription Drug changes 6/2009
The new rule CMS proposed June 1, 2009 has sent MSA proposals thru the roof! Prescription drugs must be priced using the Redbook AWP prices!

My 2nd MSA was double the first one because of the AWP pricing. What this will do is cause settlements to be delayed.

The AWP prices enforced by CMS are over 2X higher than generic drug prices!

Here is a excert from the above website:

Pricing Methodology & Related Matters

Under CMS’ new policies, Average Wholesale Price (AWP) is the pricing methodology to be utilized to calculate future Part D covered costs for those drugs related to a claimant’s workers’ compensation injury/illness. On this point, CMS states:

Effective with complete WCMSA submissions received by CMS’ Coordination of Benefits (COB) Contractor on or after June 1, 2009, where the WC related injury warrant(s) the need of prescription drugs for the ongoing treatment of the WC related injury, CMS’ independent pricing of the prescription drug amount will be calculated and priced using average wholesale price (AWP). The CMS will not use or recognize any other pricing, discounting, or calculation methods when determining the adequacy of the prescription drug amounts in WCMSA proposals. The CMS will apply the following procedures to all WCMSA proposals received on or after June 1, 2009. This procedure will also apply to all closed WCMSA cases that reopen on or after June 1, 2009, as noted below.

This change could delay a settlement bigtime. It is good reading for a IW looking at a WCMSA as part of there future settlement.

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