In a web site release on September 22nd  CMS announced plans to provide for a portal system procedure to provide valuation of prescription drugs for purposes of WCMSAs. The policy may be accessed at http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Workers-Compensation-Medicare-Set-Aside-Arrangements/Whats-New/Downloads/Upcoming-Enhancement-WCMSAP-for-PD-Information.pdf

As of October 6, 2014, portal users will be able to enter information on the new Prescription Drugs page for any new and Work In Progress case before it is submitted through the WCMSAP. Primary features of the procedure include:

  • Entry of the prescription drug information will be required, when applicable, prior to submission of a case using the portal.
  • Prescription drugs will be verified and priced using the monthly Redbook Drug Reference that is in effect at the date of submission.
  • Once a submitter obtains an applicable drug, the portal will display the following information related to the selected drug on the Prescription Drugs page: drug name, dosage, NDC, PPU (Price per Unit) and the number of years (based on Life Expectancy).
  • Once populated, users will be required to enter the drug frequency information i.e., Per Day, Per Week or Per Month and calculate the total by clicking the [Calculate Total] button.

The process would set the valuation of prescription drugs using the Redbook value at the time of the WCMSA review submission and generally assume that the treatment plan and valuation of prescription drugs would remain constant throughout the life expectancy of the individual.  The policy does not address the flexibility needed to address changes in the recovery from injury, return to work or changes in the Redbook or other valuation in the time period during which the review is pending or over the course of recovery from injury or illness.

CMS indicates that the new procedure will be incorporated in the next published version of the Workers’ Compensation Medicare Set-Aside Arrangement User Manual. The updated user manual is scheduled to be available as of October 6, 2014 and will be located under the Reference Materials menu option of the WCMSAP found at the following link: https://www.cob.cms.hhs.gov/WCMSAP/