Release of Generic Lunesta Will Result in Substantial Savings in MSAs

Lunesta, a sedative commonly prescribed to treat insomnia, recently became available in generic form. Preparing Medicare Set-aside allocation reports using generic pricing as opposed to brand pricing will produce a savings of $1.31 per pill. This will result in a substantial savings for our clients.

Importantly, FDA approved generic drug products have to meet the same rigid standards as an innovator drug. All generic drugs approved by the FDA have been deemed to have the same quality, strength, purity and stability as brand-name drugs. In addition, the generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand-name drugs. Accordingly, we highly recommend that physicians who have been prescribing Lunesta as a brand be encouraged to consider prescribing the new, much more cost-effective generic instead.

CMS Publishes WCMSA Self-Administration Toolkit

On Friday, April 11, 2014, CMS published an extensive Workers' Compensation Medicare Set-aside Arrangement (WCMSA) Toolkit.  This guide is designed to assist Medicare beneficiaries with the task of properly administering their WCMSA accounts. 

Among other topics, the Toolkit includes information about the following: 

• How to set up a WCMSA bank account;
• Different mechanisms of funding;
• Permissible expenses that may be paid from a WCMSA account;
• How to discuss the WCMSA account with health care providers;
• How bills should be calculated and paid;
• Record-keeping instructions;
• Annual documentation that must be provided to Medicare;
• Final depletion of WCMSA funds;
• Structured WCMSA accounts;
• Carry-over or exhaustion of funds annually; and
• Contact information for self-administration assistance. 

In addition, the Toolkit contains numerous letters and examples that beneficiaries can give to health care providers and pharmacies explaining the WCMSA account and billing procedures.  The Toolkit also contains examples of appropriate record-keeping for WCMSA accounts.

To access the Toolkit, click here and scroll to the bottom under downloads.  If you have any questions about this, or any other Medicare Compliance issue, please do not hesitate to contact us.