About three years ago, we posted the article, “Could you cut $185,000 from your MSA?” The crux of this article was that by simply changing one drug from brand name to generic, you could save $185,000 from the cost of a Medicare Set-aside (MSA). We provided a chart of the top 10 costliest drugs and their generic alternatives (if available) to show the stark difference between the two pricing models.

 Well, after three years, a few things have changed:

• Abilify, Nexium and Pristiq now have generic alternatives.
• The Average Wholesale Price (AWP) of our top 10 drugs has changed.
• We have added an injection (Evzio) to the list. We call the brand name version of Evzio the “settlement killer” due to its prohibitive cost in brand name form.

Our updated chart is below. Please take note of the significant savings your MSA could realize just by switching to the generic version of the drug. For example, Evzio goes from a “settlement killer” to a “settlement maker” in generic form. And 30 years of Percocet in generic form will save the MSA almost $700,000.

We are providing this list as a reference only. Drug prices do change frequently, so don’t rely on this chart to price a drug. 

Prescription drug costs can make up 70% of MSAs. By engaging a pharmacy utilization review team, we can ensure patient safety and help employers stay on top of key changes that can impact prescription costs and MSAs. Through aggressive complex pharmacy management services, the Sedgwick team helped employers reduce overall prescription drug costs by 47% in 2017. Sedgwick continues to battle the use of opioids and foster health safety, but in the cases where medications are approved, we also look to provide the most cost effective approach.

If you have questions or concerns about any Medicare compliance topic or issue, please contact our Medicare Concierge desk at medicarehelp@sedgwick.com.