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WCMSAP April updates - pregabalin and meloxicam price decreases

April 10, 2020 · Optum Settlement Solutions

The Workers' Compensation Medicare Set-Aside Portal (WCMSAP) is updated monthly based on Average Wholesale Price (AWP) data from RED BOOK®.

Updates include:

  • A significant drop in the price of pregabalin (generic of Lyrica®), an antiepileptic drug (AED) commonly prescribed for neuropathic pain, which became available in July 2019.
  • A substantial decrease in the price of meloxicam (generic of Mobic®), a non-steroidal anti-inflammatory drug (NSAID). Please refer to our previous blog for full details.
Drug Name, dose
and formulation
National Drug Code
(NDC)
Drug class Prior AWP New AWP*

Pregabalin 25mg Capsule

76282-0568-90

AED

$1.58/capsule

$0.02/capsule

Pregabalin 50mg Capsule

76282-0569-90

AED

$0.90/capsule

$0.04/capsule

Pregabalin 75mg Capsule

76282-0570-90

AED

$0.92/capsule

$0.04/capsule

Pregabalin 100mg Capsule

76282-0571-90

 AED

$1.00/capsule

$0.05/capsule

Pregabalin 150mg Capsule

76282-0572-90

AED

$1.14/capsule

$0.05/capsule

Pregabalin 200mg Capsule

76282-0573-90

AED

$1.99/capsule

$0.07/capsule

Pregabalin 225mg Capsule

76282-0574-90

AED

$2.55/capsule

$0.08/capsule

Pregabalin 300mg Capsule

76282-0575-90

AED

$2.05/capsule

$0.09/capsule

Meloxicam 15mg Tablet

76282-0153-10

NSAID

$4.25/tablet

$0.05/tablet

Meloxicam 7.5mg Tablet

76282-0152-10

NSAID

$2.78/tablet

$0.05/tablet

*Current WCMSA portal pricing

Finally, the laxative agent polyethylene glycol 3350 oral powder (MiraLAX®) for solution is no longer marketed or available as a prescription drug but is now only available over-the-counter (OTC).

FINANCIAL IMPACT OF PRICE DECREASES
With the new price decreases on pregabalin, an allocation of 60 pregabalin 300 mg capsules per month over a 20-year life expectancy is now reduced by $28,224.

We no longer expect the Centers for Medicare and Medicaid Services (CMS) to require including polyethylene glycol 3350 oral powder for treatment of constipation in the Workers’ Compensation Medicare Set-Aside (WCMSA) as there is no longer a prescription product available on the market, and this will no longer be considered a dual designation medication. This will decrease WCMSAs including polyethylene glycol by $9,792 over a 20-year life expectancy.

OPTUM WILL PROACTIVELY RESEARCH WCMSAS WITH THESE MEDICATIONS IN THE ALLOCATION
These significant changes to three commonly prescribed medications in the WCMSAs may increase the possibility of moving cases to settlement. We will be proactively reaching out to clients with previous WCMSAs that included these medications and have not yet been approved by CMS.

WHAT YOU CAN DO
We recommend carriers, TPAs, and claims handlers review cases in which meloxicam, pregabalin, and/or polyethylene glycol is prescribed and determine if these decreases may now allow for settlement.

ONGOING OPTUM SUPPORT
As an established Medicare Secondary Payer (MSP) compliance services provider, one of the Optum goals is to keep clients and the property and casualty insurance industry informed of changes affecting MSP compliance and WCMSAs. As part of our best business practices, we continually monitor RED BOOK® for changes in the AWPs of the most common medications in WCMSAs, as well as for new generic medications that come to market, and we will keep the industry informed.

Sources:

1.      Redbook - http://www.micromedex.com/products/redbook/awp/ (requires log in)

2.      WCMSA Portal - https://www.cob.cms.hhs.gov/WCMSA/login (requires log in)


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