Medicare Set Aside - ANS medical cost containment help bring all the pieces togetherAs we all know, injured worker treatment regimens relying heavily on costly prescriptions is the unfortunate norm. On top of that, pharma costs are continually rising, surpassing general and medical cost inflation. It seems that Payers can’t catch a break. To add insult to injury, Medicare Part D came into existence as part of the Medicare Modernization Act, which further mandated the inclusion of prescription drug coverage in Medicare Set-Asides. Accounting for prescription drug coverage in the face of inflating pharma costs and excessive prescriptions is the perfect storm for excessive MSAs, resulting in fewer settled claims.

Mitigating MSA Part D Exposure

To reach settlement quickly and with optimal results for both Payer and Claimant, a comprehensive expert approach is necessary. At ANS we mitigate Medicare Set Aside Part D exposure with a unique three step approach.

PharmReview – Pharm Ds examine the worker’s current treatment and recommends modifications, often finding similar or superior results that can be achieved using less expensive drugs or alternate therapies, producing improved results for both the worker and the carrier.

PharmIntervention – To address these recommended conversions, an ANS Nurse Expert meets with the injured worker’s physician to develop a new pharmaceutical regimen based on the expert review and recommendations. Significant MSA savings are often achieved by formally discontinuing previously prescribed medications, allowing their removal from the MSA.

PharmCompliance – To ensure hard dollar savings and a positive therapeutic outcome, each case requires proactive management. An ANS Clinical Liaison Officer is assigned to every case and employs protocols to ensure the new regimen is adhered to by both the treating physician and claimant.

Experience shows that ANS Solution’s comprehensive Pharmacotherapy Review Program can reduce pharma costs by as much as 25%. Settlements are optimized, and achieved faster with lower costs. ANS’ program often leads to the claimant obtaining an improved quality of life.

To learn more contact us.