Elmhurst, IL – Members of the National Alliance of Medicare Set-Aside Professionals’ Evidence-Based Medicine Committee recently urged CMS representatives to use more sensible pharmacy allocations in Workers’ Compensation MSAs (WCMSAs) that have chronic opioid prescriptions.
CMS’s policy is to allocate the cost of opioids over the full life expectancy of the beneficiary at the same dosage and frequency that have been prescribed in the six to 12 months prior to MSA submission. NAMSAP says the policy does not follow evidence-based guidelines and effectively sanctions harmful, long-term opioid use.
Joined by Louisiana Senator Bill Cassidy’s staff, NAMSAP Committee Co-chairs Gary Patureau and Amy Bilton discussed the issue with Sherri McQueen, Steve Forry and John Jenkins at CMS’s Office of Financial Management on December 11. At Ms. McQueen’s request, the organization recapped its points and recommendations in a December 18 letter.
NAMSAP maintains that the recommendations section of the WCMSA approval letter sends the wrong message to the beneficiary about the efficacy and safe duration of opioid usage without acknowledging the likelihood of misuse and abuse when taken chronically. It also suggested that these WCMSAs overfund beneficiaries’ anticipated future medical needs because the opioids are priced in dosages that were never meant to be taken over life expectancy.
NAMSAP’s December 18 letter states, “In our experience, 80 percent of WCMSAs are overfunded.”
Another concern is that the WCMSA monies are given to the beneficiary directly without a gatekeeper to oversee the post-settlement opioid use.
Responding to CMS’s request for input on how to otherwise handle opioids in WCMSAs, NAMSAP proposed CMS use its own Reference Guide to bring evidence-based guidelines to the recommended WCMSA allocations for claims with opioid prescriptions. The organization recommended using the Centers for Disease Control and Prevention (CDC) guidelines for tapering beneficiaries from long-term opioids at a rate of 10 percent per week until fully weaned. Exceptions could be made for short-term, post-operative opioid use and allocations for terminal patients and for those with malignancy. NAMSAP also recommended that WCMSAs involving beneficiaries who have had negative Urinary Drug Screens within the last six months receive zero opioid MSA allocation recommendations to prevent the likelihood of diversion.
The meeting was part of NAMSAP’s ongoing efforts to address opioid misuse in WCMSAs. The organization wants to eliminate or at least minimize the WCMSA’s role in perpetuating the opioid epidemic in the country.
Click here to read the NAMSAP Letter to Shari McQueen