Part D of the Medicare Modernization Act & WCMSAs

***ALERT***New CMS Memorandum dated July 24, 2006 regarding WCMSAs and Prescription Drugs for 2007. Please click on the Downloads below for the document.***ALERT***

Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), prescription drug coverage under Medicare will be available starting on January 1, 2006.

All Workers' Compensation (WC) settlements that occur on or after January 1, 2006, must consider and protect Medicare's interests when future treatment includes prescription drugs along with the future medical services that would otherwise be reimbursable by Medicare. The recommended method to protect Medicare's interests is to include a Workers' Compensation Medicare Set-aside Arrangement (WCMSA) as part of the WC settlement.  (Ref: 12/30/05 Memo Q1)

For WCMSA proposals received by CMS' Coordination of Benefits Contractor (COBC) on or after January 1, 2006, the submitter's cover letter must include separate amounts for: (1) future medical treatment, and (2) future prescription drug treatment.  In addition, the cover letter must include an explanation as to how the submitter calculated the future prescription drug treatment amount (i.e., actual costs, average wholesale price, etc.). (Ref: 12/30/05 Memo Q2)

Please click on the Download below for information concerning the inclusion of future prescription drug treatment in Worker's Compensation Medicare Set-aside Arrangement (WCMSA) proposals. 

For more information concerning Part D and Coordination of Benefits (COB), please click on the MMA COB Guidance link below.