WASHINGTON—The Centers for Medicare & Medicaid Services has released a

memorandum clarifying the requirements to include Medicare Part D prescription drugs

in Workers’ Compensation Medicare Set-Aside Arrangements.

The purpose of the memorandum issued Friday is to clarify past guidance on

prescriptions provided to Medicare beneficiaries for “off-label and/or unlabeled

outpatient uses and whether these drugs are considered covered by Medicare Part D and,

therefore, appropriately included in a Medicare Workers’ Compensation Set-aside

Arrangement proposal,” the federal agency said.

For Part D drugs to be covered by Medicare, and thus included in a workers

compensation set-aside, they should be prescribed for outpatient use as approved under

the Federal Food, Drug, and Cosmetic Act (21 U.S.C.A. § 301 et seq.), CMS’

memorandum states.

A workers comp MSA is an allocation of funds from a claims settlement, judgment or

award that is used to pay for an individual’s future medical and prescription drug

treatments. Workers comp MSAs are required to avoid Medicare paying for health care

expenses when other sources of funding are available.