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Through an integrated medical, pharmacy, claims and legal approach, we deliver insights to help navigate the ever‑changing Medicare Secondary Payer landscape.

Recent blog posts

January 04, 2022 · Medicare Insights Team
One year after it was signed into law, the Provide Accurate Information Directly ("PAID") Act went live on December 11, 2021. The Act requires the Centers for Medicare & Medicaid Services (CMS) to expand its process to identify whether a claimant is currently or has– in the last three years– been enrolled in Medicare Part C and/or Medicare Part D coverage. With this information, insurers can better identify a claimant’s Medicare plans and avoid unnecessary litigation. Read more...
December 09, 2021 · Medicare Insights Team
The U.S. Food and Drug Administration (FDA) approved a new medication to prevent episodic migraine (fewer than fifteen headache days per month) on September 28, 2021. This approval allows AbbVie, Inc. to market Qulipta - a once daily oral calcitonin gene-related peptide (CGRP) receptor antagonist - for migraine prevention. Qulipta is not indicated for the acute treatment of migraines like other oral CGRP receptor antagonists on the market, such as Ubrelvy™ (ubrogepant) and Nurtec® ODT (rimegepant). Qulipta is the second oral CGRP receptor antagonist to be approved for prevention of episodic migraine. Read more...
November 18, 2021 · Clinical Team
In April 2021, Sanofi Consumer Healthcare released a new, over-the counter (OTC) medication called Zantac 360°. Read more...
October 11, 2021 · New WCMSA Reference Guide
The Centers for Medicare and Medicaid Services (CMS) released Version 3.4 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide on 10/5/2021. Read more...
September 16, 2021 · Medicare Insights Team
Approved by the FDA in August 2021, the first generic of Duexis, ibuprofen-famotidine, is now available and is included in the Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) as of September 2021. Read more...
August 12, 2021 · Medicare Insights Team
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. Read more...
May 05, 2021 · Medicare Insights Team
The Centers for Medicare and Medicaid Services (CMS) released Version 3.3 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide, which clarifies how to calculate the seed money (initial deposit) in a structured WCMSA. Read more...
April 28, 2021 · Medicare Insights Team
The generic of Hysingla ER, hydrocodone bitartrate extended-release (ER) tablets, was released in March 2021 and became available for allocation in Workers’ Compensation Medicare Set-Asides (WCMSAs) as of early April 2021. Read more...
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