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Member, Beacon International Group, Ltd.
WASHINGTON—The Centers for Medicare & Medicaid Services has released a memorandum clarifying the requirements to include Medicare Part D prescription drugs in Workers’ Compensation Medicare Set-Aside Arrangements.
The purpose of the memorandum issued Friday is to clarify past guidance on prescriptions provided to Medicare beneficiaries for “off-label and/or unlabeled outpatient uses and whether these drugs are considered covered by Medicare Part D and, therefore, appropriately included in a Medicare Workers’ Compensation Set-aside Arrangement proposal,” the federal agency said.
For Part D drugs to be covered by Medicare, and thus included in a workers compensation set-aside, they should be prescribed for outpatient use as approved under the Federal Food, Drug, and Cosmetic Act (21 U.S.C.A. § 301 et seq.), CMS’ memorandum states.
A workers comp MSA is an allocation of funds from a claims settlement, judgment or award that is used to pay for an individual’s future medical and prescription drug treatments. Workers comp MSAs are required to avoid Medicare paying for health care expenses when other sources of funding are available.