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CMS to launch Medicare set-aside calculator for prescription drug costs


The U.S. Centers for Medicare and Medicaid Services plans to launch an online tool allowing workers compensation claim payers to determine how much money should be allocated for prescription drugs in Medicare set-aside accounts.

The CMS Workers' Compensation Medicare Set-Aside Portal will include the calculator as of Oct. 6, CMS said last week in a statement.

The Medicare Secondary Payer Act requires self-insured employers and insurers to act as primary payers for workers comp and liability claims involving Medicare beneficiaries. CMS advises workers comp payers to set up Medicare set-aside accounts to pay for future medical costs for a beneficiary's injury.

Medicare Secondary Payer experts have said that CMS often advises payers to place higher-than-anticipated amounts into Medicare set-aside accounts, and that those higher projections often are based on prices for medications being taken by claimants.

The tool will allow workers comp payers to search for medications used by a workers comp claimant, and determine how much money should be placed into a set-aside account, CMS said. The calculation will be based on information such as the drug's dosage, frequency and price per unit, as well as the claimant's life expectancy.