Version 2.9 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has now been released and is available in the Download section of the Workers’ Compensation Medicare Set Aside Arrangements page on CMS.gov. The new version includes updates to the CDC Life Table for 2015 as well as updates for spinal cord stimulators and Lyrica.
Lyrica is among several FDA approved drugs used for off-label indications. These drugs may be covered under Medicare if the carrier determines the use to be medically accepted. There are many off-label indications that are listed in recognized compendia and peer-reviewed sources; thus, they would be covered under the Part D Benefit, and should also be included in a WCMSA. Lyrica is cited as an example of this. One of its off -label uses is for the treatment of neuropathic pain resulting from spinal cord injury. Research has also shown that Lyrica yields positive results for the treatment of radicular pain (a form of neuropathic pain). Spinal cord neuropathy includes injuries directly to the spinal cord or its supporting structures causing nerve impingement that results in neuropathic pain. Lyrica is considered acceptable for pricing as a treatment for WCMSAs that include diagnoses related to radiculopathy because radiculopathy is a type of neuropathy related to peripheral nerve impingement caused by injury to the supporting structures of the spinal cord. Please see section 1.1 of the guide for a full summary of changes.