New generic medication average wholesale price decreases and WCMSA cost reduction examples

The Workers’ Compensation Medicare Set-Asides portal is updated monthly by the Centers for Medicare and Medicaid Services (CMS) based on AWP data from RED BOOK®.  

Optum continually monitors the average wholesale price (AWP) of the most common medications in Workers’ Compensation Medicare Set-Asides (WCMSAs) to help our clients properly assess their WCMSA exposure and achieve the lowest possible allocations. Review of the recent WCMSA portal update indicates AWP price decreases for the medications outlined below.

• All strengths of hydrocodone-acetaminophen containing 300 mg of acetaminophen (generic of Vicodin®) have decreased by a range of 66% to 76%
• Oxycodone-acetaminophen 7.5-325 mg and 10-325 mg tablets (generic of Percocet®) have decreased by 44% and 46%, respectively
  NOTE: The 2.5-325 mg and 5-325 mg strengths of oxycodone-acetaminophen tablets are not affected by a price change
• Both strengths of buprenorphine sublingual tablets (generic of Subutex®) have decreased by 91%.
• Buprenorphine-naloxone 2-0.5 mg sublingual tablets (generic of Suboxone®) has decreased by 22%
  NOTE: The 8-2 mg strength of buprenorphine-naloxone sublingual tablets are not affected by a price change
• Bupropion XL 150 mg tablets (generic of Wellbutrin XL™) has decreased by 58%
• Lidocaine 5% patches (generic of Lidoderm®) has decreased by 31%

†Topical lidocaine is not included in WCMSA allocations for treatment of localized neuropathic pain, but this price decrease may positively affect settlements including allocations for this medication

Impact to your WCMSA

Significant reductions in WCMSAs could 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:

• 90 tablets per month of hydrocodone-acetaminophen 10-300 mg, a common dose for treatment of chronic pain, would decrease by over $24,000
•  90 tablets per month of oxycodone-acetaminophen 10-325 mg, a common dose for treatment of chronic pain, would decrease by over $2,300
• 60 sublingual tablets per month of buprenorphine 8 mg, a typical dose for maintenance treatment of opioid agonist dependence, would decrease by over $101,000

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.
As part of our best practices, we monitor RED BOOK for AWP changes to the most common medications in WCMSAs as well as new generic medications that come to market to keep the industry informed when these changes occur and WCMSA exposure is positively affected.   

What you can do

Optum Settlement Solutions recommends that 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.

View recent Medicare Insights blog posts.

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