Meloxicam price decrease and the impact on Medicare Set Asides (MSAs)
Medications comprise a large proportion of Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs). And, as the population ages, more claimants will become eligible for Medicare coverage. So, it is important to stay up-to-date on medication costs and how they affect WCMSAs.
Brand-name medication manufacturers typically increase the cost of their products 10 percent per year. Increases are often announced in January and July. Fortunately, formularies implemented at the Pharmacy Benefits Management (PBM) level and a growing number of state formularies are working to decrease medication claim costs. Formularies are effective initial tools to help keep medication costs down. However, there are times when despite best practices, the cost of prescribed medications can result in a high MSA allocation, making settling claims unlikely. The Optum Settlement Solutions clinical team can often recommend cost-effective alternatives and opportunities to improve claimants’ clinical well-being.
January 2020 brand-name medication cost increases
Our most recent pricing review for brand-name medications commonly seen in WCMSA allocations revealed the usual biannual cost increases, averaging eight percent in January 2020. Typical WCMSA medications with their potential therapeutic uses, including off-label uses, are listed below.
All pricing information below is from RED BOOK™. There are cost-effective alternatives for claims involving one or more of these medications. The Optum clinical team can likely recommend guideline-supported therapy alternatives to reduce the claim’s WCMSA allocation and improve clinical outcomes.
|Drug name, dose
|National Drug Code (NDC)||Drug class||Prior AWP*||New AWP**|
|Meloxicam 15 mg tablet||76282-0153-10||NSAID||$4.25/tablet||$0.05/tablet|
|Meloxicam 7.5 mg tablet||76282-0152-10||NSAID||$2.78/tablet||$0.05/tablet|
*Current WCMSAP price
**Expected 4/2020 WCMSAP price
Impact to MSAs
To put this price change into perspective, meloxicam 15 mg #30 per month over a 20 year life expectancy, will decrease the WCMSA by $30,240. If meloxicam 7.5 mg #60 per month is prescribed over a life expectancy of 20 years, the savings related to the WCMSA is $39,312.
Proactively researching WCMSAs with meloxicam allocations
We rarely see this large a price decrease on such a commonly prescribed medication in the WCMSA field. We are proactively reaching out to clients whose previous WCMSAs had meloxicam allocated.
Optum will be contacting clients to advise them of previously prepared WCMSAs that have not been approved by the Centers for Medicare and Medicaid Services (CMS) that include meloxicam and could benefit from a revision.
What you can do
We also recommend that carriers, TPAs and claims handlers proactively review cases where meloxicam is prescribed and determine if this decrease in price may now help move a case toward settlement.
Ongoing support from Optum
As an established Medicare Secondary Payer (MSP) compliance services provider, one of Optum’s 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 AWP changes of the most common medications in WCMSAs as well as generic medications that come to market and will continue to keep the industry informed.