Dr. Nahla Rizkallah, Senior Clinical Pharmacist
Allocation and pricing of medications within the Workers Compensation Medicare Set-Aside Arrangement (WCMSA) Part D is done so in accordance with the WCMSA Reference Guide as published by Center for Medicare and Medicaid Services (CMS). As a result, WCMSA medications are priced using the lowest average wholesale price (AWP) by the recognized proprietary source: Truven Health Analytics’ Red Book database. Further, generic medications are priced at the lowest non-repackaged AWP.
AWP is considered the “sticker price” and rarely what is actually paid; it is used as a benchmark in drug pricing, and it is an ever-changing number!
ExamWorks Clinical Solutions continually monitors Red Book for real-time changes to AWP for medications used to treat the injured worker. Micro Labs USA, Inc. has released a new product on 10/1/18, offering a new lowest AWP for all strengths of generic Celebrex, celecoxib. Please see comparison chart below.
|Drug and strength||Previous Lowest AWP||New Lowest AWP|
In the past, celecoxib has been offered as a cost-saving alternative to therapy with meloxicam only, due to higher cost of therapy. However, the new pricing provides a significant cost mitigation opportunity for a multitude of NSAID-containing medication regimens. Please see the table below outlining the most frequently prescribed NSAIDs and their cost. This illustrates that with the new pricing, celecoxib can be offered as an alternative to a much wider range of medications.
|Diclofenac EC 75mg||$0.54|
|Diclofenac ER 100mg||$2.69|
Chronic use of NSAIDs may expose the patient to potential cardiovascular (CV) and gastrointestinal (GI) risks. The use of celecoxib addressed both of those concerns. It is well known that prolonged NSAID use places the patient at an increased risk of serious gastrointestinal (GI) adverse reactions, including bleeds, ulceration, and perforation—all of which could be fatal. Celecoxib is the only selective cyclooxygenase-2 (COX-2) inhibitor NSAID currently available on the market. Selectivity for the COX-2 enzyme is known to be GI protective. Celecoxib, therefore, is the medication of choice for patients with GI risk factors, such as GERD and acid reflux.
ExamWorks Clinical Solutions best practices in providing the most accurate and defensible MSA is to utilize technology and compendia databases, which are recognized and supported by the CMS to support inclusion or exclusion of a drug under the Part D benefit.
ExamWorks Clinical Solutions continues to monitor changes in medication pricing as well as availability of generic equivalents within the marketplace. For questions about medications, please contact Dr. Nahla Rizkallah, PharmD at 678-256-5086 or firstname.lastname@example.org