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Generic Lyrica® price drop and other updates ― significant MSA savings

by Mary McNitt | Sep 09, 2019

The Workers’ Compensation Medicare Set Aside (WCMSA) portal has been updated to reflect new lower cost generic formulations of Lyrica®, as well as additional medication price decreases (updates listed below).

The month of August brought price drops for the generic medications pregabalin, baclofen, oxycodone-acetaminophen, ramelteon and solfenacin. Pregabalin is the generic form of Lyrica, which is commonly used to treat neuropathic pain and is frequently prescribed in workers’ compensation claims. Oxycodone-acetaminophen is a combination of a short-acting opioid and acetaminophen used to treat pain. Baclofen is a widely-used skeletal muscle relaxant prescribed to relieve muscle spasms. Ramelteon is used to help with insomnia. And, solifenacin is indicated for bladder muscle dysfunction with symptoms of urinary urgency, incontinence and frequency.

Effect on WCMSA costs
As more generic manufacturers bring products to market, price pressure tends to bring down costs. The chart below shows the generic products that we expect will significantly reduce many MSA drug allocations. Cases that include the below medications will see significant decreases to the Medicare Set-Aside (MSA) as a result of these price reductions.

Medication Manufacturer Strength NDC Number New unit
price
Previous unit
price
Percent
decrease
Baclofen Eywa 20 mg 71930000712 $0.55 $1.01 45.35%
Oxycodone-acetaminophen Eywa 325 mg-7.5 mg 71930004612 $0.71 $2.57 72.45%
Oxycodone-acetaminophen Eywa 325 mg-10 mg 71930004712 $0.78 $3.37 76.85%
Pregabalin Major 25 mg 904699104 $1.58 $8.42 81.20%
Pregabalin Major 50 mg 904699261 $0.90 $7.58 88.06%
Pregabalin Major 75 mg 904700061 $0.92 $7.58 87.84%
Pregabalin Major 100 mg 904700161 $1.01 $7.58 86.70%
Pregabalin Major 150 mg 904700261 $1.14 $7.58 84.95%
Pregabalin Major 200 mg 904700304 $2.00 $8.42 76.30%
Pregabalin Major 300 mg 904700504 $2.06 $8.42 75.57%
Ramelteon Zydus Pharm. 8 mg 70710134401 $13.99   $15.56  10.10%
Solifenacin Celltrion 5 mg 72606000901 $0.34 $3.86 91.28%
Solifenacin Celltrion 10 mg 72606001001 $0.34 $3.86 91.28%

Please note that REDBOOK Average Wholesale Price (AWP) is subject to change and this pricing is subject to an increase or decrease in the future.

Optum Workers’ Comp and Auto-No Fault (OWCA) recommendation
CMS will utilize the lowest AWP when reviewing WCMSAs, therefore the lower pricing of these drugs will impact prescription costs. It is our recommendation that carriers, TPAs and claim handlers review cases where the above noted medications are prescribed to determine the benefit from the decreased costs. We will proactively reach out to our clients in reference to previously completed WCMSAs where these medications were allocated.

Future updates
We continually monitor the RED BOOK® Average Wholesale Price (AWP) changes for the most common medications in WCMSAs, as well as generic medications that come to market, and will keep the industry informed.

As an established Medicare Secondary Payer (MSP) compliance services provider, one of OWCA’s goals is to keep clients and the property and casualty insurance industry informed of changes affecting Medicare Secondary Payer (MSP) compliance and WCMSAs.

Sources:

  1. RED BOOK http://www.micromedex.com/products/redbook/awp/
  2. WCMSA portal https://www.cob.cms.hhs.gov/WCMSA/login

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