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Medication AWP decreases may lead to lower WCMSA allocations

August 12, 2021 · Medicare Insights Team

The Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) is updated monthly by the Centers for Medicare and Medicaid Services (CMS) based on average wholesale price (AWP) data from RED BOOK®  

Optum continually monitors the average wholesale price (AWP) of the most common medications in WCMSAs to help our clients properly assess their exposure and achieve the lowest possible allocations. Our recent review of the WCMSAP update indicates AWP price decreases for the following medications:

  • All strengths of omeprazole enteric-coated capsules have decreased 45% to 98%
  • Both strengths of bupropion immediate-release tablets have decreased by approximately 53%
     
Medication name, dose and formulation National Drug Code (NDC) Therapeutic class Prior AWP
June 2021 WCMSA portal pricing
New AWP
August 2021 WCMSA portal pricing
Omeprazole 10 mg capsule 00781-2859-01 Proton pump inhibitor $3.98 per capsule $0.14 per capsule
Omeprazole 20 mg capsule 00781-2868-01 Proton pump inhibitor $0.26 per capsule $0.14 per capsule
Omeprazole 40 mg capsule 00781-2234-01 Proton pump inhibitor $6.68 per capsule $0.14 per capsule
Bupropion 75 mg tablet 23155-0191-01 Antidepressant $0.72 per tablet $0.33 per tablet
Bupropion 100 mg tablet 23155-0192-01 Antidepressant $0.96 per tablet $0.44 per tablet

 

Impact to your WCMSA

Reductions in WCMSAs will be realized with the above noted reductions for these select medications. Consider the following examples (based on a 20-year life expectancy).

A WCMSA that includes:

  • 30 capsules per month of omeprazole 40 mg, a dose often seen for treatment of gastric conditions, would decrease by over $47,000
  • 90 tablets per month of bupropion 100 mg, a typical dose for treatment of depression, would decrease by over $11,000
     

Optum working for you

Optum Settlement Solutions will reach out to clients with previously completed WCMSAs that include the above medications to offer a revised WCMSA that will reflect the price decreases.

As an established Medicare Secondary Payer (MSP) compliance services provider, one of our goals is to keep our clients and the industry informed of changes affecting MSP compliance and WCMSAs.
 

What you can do

Optum Settlement Solutions recommends that employers, carriers, third-party administrators (TPAs), and claim handlers review active claims in which any of the above medications are prescribed to determine if the price decreases may now facilitate settlement. Follow our blog to stay informed on the latest industry information and trends.

Sources:
1.     RED BOOK - https://www.ibm.com/products/micromedex-red-book (Subscription required)
2.     WCMSA Portal - https://www.cob.cms.hhs.gov/WCMSA/login

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