On June 2, 2009, CMS published new guidelines with regard to prescription drug documentation for Medicare Set Aside allocators.  A copy of the memo can be found on the CMS website.
The memo includes these main points:

Pricing of prescription drugs is to be based on the current REDBOOK Drug Reference
Allocators are to use the lowest priced generic drug listed in the reference
Tapering WILL BE CONSIDERED by CMS as recommended by the treating physician
Off-label use does not preclude the prescriptions from the allocation and are allowed so long as the drug is …

The MARC group is seeking transparency between CMS and Primary Plans wtih resprect to conditional payment information, application of state law in the determination of the amount of conditional payments that may be collected, a right of review of CMS decisions on conditional payments, and clear methods of the identification of who is “Medicare eligible” by a primary plan.
Attorny Bill Van Wambeke is the NAMSAP representative on the committee.  If you would like additional information on the issues being raised in Washington, please visit the MARC website at www.marccoalition.com. 

CMS has announced it intends to clarify the language in recovery scenarios where occupational exposures occurred prior to the effective date of the Medicare Secondary Payer Act.  In a recent town hall meeting, Barbara Wright, Bill Decker and others explain some of the reporting requirements and have plans to further clarify the Medicare as Secondary Payor recovery language.  Additional town hall meetings have been scheduled as CMS ramps up for the upcoming mandatory reporting requirements.  Stay tuned..

On May 1st, CMS released a new memo clarifying the Life Expectancy issue for all Medicare Set-Asides (MSA).  Beginning July 1, 2008, all MSA’s must reference the CDC’s Life Expectency Table 1 when determining a beneficiary’s total life expectency.  This table reveals the data for the total US population.  Previously allocators could use other CDC tables which were broken out by race and gender.