Significant medication average wholesale price decreases for WCMSAs

To help our clients achieve the lowest possible Workers’ Compensation Medicare Set-Aside (WCMSA) allocations, Optum continually monitors the average wholesale price (AWP) of the most common medications seen in a WCMSA. The following outlines the most recent price decreases for a few of these medications.

December 2020

·         The lowest AWP of famotidine (generic of Pepcid®) products has decreased by ~91%.

January 2021

• The lowest AWP of celecoxib 200 mg (generic of Celebrex®) has  decreased by ~82%
  NOTE: The 50 mg and 100 mg strengths of celecoxib are not affected by a price change
• The lowest AWP of all strengths of aripiprazole (generic of Abilify®) has decreased by a range of 82% to over 99%
• The lowest AWP of all strengths of sertraline (generic of Zoloft®) has decreased by a range of 80% to 85%

*November 2020 WCMSA portal pricing
**December 2020 WCMSA portal pricing
† January 2020 WCMSA portal pricing

Impact to your WCMSA

Significant reductions in WCMSAs could be realized with above-noted reductions in AWP for these select medications. Consider the following examples:

• A WCMSA that includes 60 tablets per month of famotidine 40 mg, a typical dose for prevention of NSAID-induced gastric ulcers, would be decreased by over $43,000 (20-year life expectancy)
• A WCMSA that includes 30 tablets per month of aripiprazole 15 mg, a typical dose for adjunctive treatment of depression, would be decreased by over $218,000 (20-year life expectancy)
• A WCMSA that includes 30 tablets per month of sertraline 100 mg, a typical dose for treatment of depression, would be decreased by over $15,000 (20-year life expectancy)

Optum working for you

Optum Settlement Solutions will reach out to clients with previously completed WCMSAs that include any of 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 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 AWP changes on the most common medications in WCMSAs as well as new generic medications that come to market and will keep the industry informed.

What you can do

Optum Settlement Solutions recommends that carriers, third-party administrators (TPAs), and claim handlers review active claims in which famotidine, celecoxib (strength noted above), aripiprazole or sertraline 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