Allsup and PRIUM partner to address pharmacy regimens and costs for MSAs

PRIUM and Allsup Medicare Secondary Payer Compliance Services have joined forces to address pharmacy regimens and costs before submitting Medicare Set-Asides to the Centers for Medicare and Medicaid Services.

“Skyrocketing pharmacy costs are impacting settlements, and Drug Utilization Reviews are not enough to receive CMS approval for drug costs”

"Skyrocketing pharmacy costs are impacting settlements, and Drug Utilization Reviews are not enough to receive CMS approval for drug costs," said Rob Sokol, director of Medicare Secondary Payer Compliance for Allsup. "CMS needs the primary treating physician's written agreement and proof of medication changes to remove drug costs from the calculation, and that's where PRIUM's Physician Pharmaceutical Review (PPR) comes in."

When casualty claims reach a financial or drug utilization threshold, Allsup recommends that clients engage PRIUM to work with treating physicians to adjust the regimen prior to submitting the MSA to CMS. Using evidence-based medicine, PRIUM's physicians collaborate with treating physicians on the most clinically appropriate and related drug therapy.

"These collegial discussions produce agreement on new drug therapy in 67 percent of our cases and case management oversight helps implement the changes," said Mark Pew, PRIUM's senior vice president of business development.

While focusing on patient safety and quality of life, drug therapy changes typically result in lower drug costs. "The average claim's actual savings was $8,575, yielding a return on investment of $6.65 for every dollar spent with us," Pew added, noting the projected savings on an average claim was $33,244 over 24 months.