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What's New

New information regarding upcoming Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) changes are posted as the information becomes available.  Items remain on this page for the current year and are then moved to the Archive page.

November 17, 2014 – Notice of Hydrocodone Combination Product Coverage Changes in Medicare Part D Effective for WCMSA Proposals Submitted on or after January 1, 2015

In October 2014, the U.S. Drug Enforcement Administration rescheduled all hydrocodone combination products from C-III controlled substances to C-II controlled substances. (Refer to U.S. Drug Enforcement Administration. Schedules of Controlled Substances: Rescheduling of Hydrocodone Combination Products from Schedule II to Schedule III. Final Rule 8/22/2014.) This may result in more frequent provider visits for beneficiaries to obtain prescriptions for hydrocodone combination products as refills are now prohibited.

Normally, C-IIIs required a new prescription after five refills or after six months, whichever occurs first. C-IIs require new prescriptions at intervals no greater than 30 days; however, a practitioner may issue up to three consecutive prescriptions in one visit authorizing the patient to receive a total of up to a 90 day supply of a C-II.

For this reason, and to ensure appropriate future funding, Medicare WCMSA guidelines will change on January 1, 2015 for all new cases submitted after that date to:

At a minimum, allocate 4 healthcare provider visits per year when schedule II controlled substances (including hydrocodone combination products) are used continuously unless healthcare provider visits are more frequent per medical documentation.

Please note that WCMSA cases submitted to CMS before January 1, 2015, closed due to missing, incomplete and/or inadequate supporting documentation (or any other reason), and subsequently re-opened after January 1, 2015, will also be subject to a review that includes the C-III controlled substances changes due to rescheduling by the DEA.

September 22, 2014

A new training document  titled “Upcoming Enhancement to the Workers’ Compensation Medicare Set Aside Portal (WCMSAP) for Collection of Prescription Drug Information” has been posted to the Downloads section at the bottom of this page.