Is now the time to re-do that expensive MSA? Recent availability of generics to replace expensive drugs could mean big reductions

By Sarah Hegener Anglin, Esq.

It is no secret that costly Medicare Set-Asides (MSAs) can be an obstacle when settling a workers’ compensation claim. Prescription drugs are almost always the main cost driver of a claimant’s MSA, especially when brand name medications are being prescribed. One of the most effective ways to minimize the cost is to identify generic versions of medications that can be prescribed in place of the brand name drugs. Generic versions of many common pain medications prescribed to workers’ compensation claimants such as OxyContin, Topamax, and Norco are available in generic form, and can result in cost savings of up to $10 per pill or more when the generic is prescribed in place of the brand name medication.

Neurontin and Lyrica, two medications commonly prescribed for nerve pain, were only available in brand name formulations for many years. These medications are very expensive, and when prescribed, commonly constitute a significant portion of a claimant’s MSA. Both drugs are now available in generic form. A 600mg pill of Neurontin can run as high as $11 per pill, where generic gabapentin can be purchased for less than $1 per pill. Figures are similar for Lyrica and the new generic, pregabalin. This means big cost savings on a claimant’s MSA!

If your ability to settle a workers’ comp claim is being held up by an expensive MSA, now may be the time to look into generic formulations of medications as a way to minimize costs. Doctors are usually willing to prescribe generic drugs, as most are just as effective as the brand name formulations and claimant’s attorneys are often willing to agree to the changes, understanding that cooperation may lead to a settled claim. The claimant’s attorney knows that a higher MSA means no settlement for anyone, including no payment of the attorney’s fee. Once generics are being prescribed in place of brand name drugs, you can have the claimant’s MSA updated to factor in reduced medication costs.

Frequently, doctors do not know how much more expensive brand name drugs are compared to generics. We recommend utilizing the authorized treating physician to explain your goal in reducing costs and providing the doctor with a questionnaire. It can be effective to get the claimant’s attorney in agreement with the plan and to tell the doctor that both parties are on board.