Medicare Part D Settlement Services

Services that decrease medical expenses

It can be difficult to navigate the cost and clinical appropriateness of medications included in the Part D allocation of a Workers' Compensation Medicare Set-Aside Arrangement (WCMSA). Let PRIUM's WCMSA Clinical Review Solution simplify this process by ensuring that only necessary medications are included in the final WCMSA settlement.

Did you know that Part D allocations now account for nearly 70 percent of the costs in a WCMSA settlement, with the payer given responsibility for a disproportionate amount of those expenses? Additionally, the U.S. Centers for Medicare & Medicaid Services (CMS) does not base Part D allocations on clinical appropriateness. As a result, payers must submit proof of any discontinued medication to be considered in a final MSA calculation.

This means it's more essential than ever to ensure that medications included in the settlement result in optimal outcomes for both the payer and injured worker. That's where PRIUM's WCMSA Clinical Review Solution can help.

Our comprehensive solution is more effective at lowering Part D workers' compensation expenses because we directly engage the treating physician in a collaborative discussion using evidence-based medicine. The collegial nature of the discussion with PRIUM's intervention team often results in a modified treatment plan. Once an agreement is reached, we attempt to secure a written agreement and then coordinate oversight to ensure implementation of the modified treatment plan. If physicians choose not to cooperate, PRIUM begins managed care consultation.

The result? A detailed clinical analysis report of our Part D recommendations, response from the prescribing physician and necessary documentation on the altered regimen, and discontinuation of the inappropriate medications.

Here's how PRIUM WCMSA Part D services work:


Interested in reducing your Part D expenses? Learn how we acheived optimal WCMSA results for our clients by downloading our white paper, co-authored by ISO Claims Partners.