With the May 14th publication of the CMS policy that allows MSA providers to exclude off label drugs from the MSA allocation reports, the value of pharmaceutical drug reviews as an option in helping to reduce drug costs has  been highlighted.  

Current CMS drug pricing policy is consideration of all evidence in making a MSA determination, including medical evidence of current actual tapering.  As a value added service, our MSA reports will include the option of completion of a pharmaceutical drug review in the report.  Upon request on our intake form, two drug tables will be included in our MSA reports: The 1st table will be based on the pharmaceutical drug review recommendations. The 2nd drug table addendum will be based on lifetime pricing of the current medications. The purpose of two sets of tables is drug therapy management. The  total cost for a MSA allocation report including a drug review by licensed pharmacists who are also clinical assistant professors at the University of Florida College of Pharmacy is only $2,500.00!  The pharmaceutical drug review will incorporate both clinical and financial concerns with a view to drug cost reduction so the claim can settle. There is also an option to request a targeted Intervention letter from the pharmacist to the physician when signed consent is given by the claimant.

To take full advantage of possible MSA reductions, it is vital that you select an MSA provider that has well trained  pharmacists who are able to navigate the FDA guidelines, Drugdex, and other drug compendia referenced in the CMS policy memo. Our firm will continue to diligently seek ways to mitigate the high cost of medications through drug substitutions or tapering based on contra-indications, duplication of drugs, over-utilization and lifetime medical impact on the claimant. Nursing, pharmaceutical and legal reviews of drugs and other MSA medical costs are more legally defensible then an MSA with no medical or pharmaceutical basis for drug reductions!   

This new CMS drug policy continues to have great impact on MSA recommendations and CMS approval. As always, should you have questions about MSA drug costs or any other MSA issues, we are here to help.