MSP Compliance Blog


Expert summary, analysis and recommendations on issues impacting Medicare Secondary Payer compliance.

Tower Premier Webinar: A Prescription for Settling Legacy Claims

Posted on April 20, 2020 by Tower MSA

As claims age, the percentage of spend for prescription drugs increases.  Further, as claims age, the likelihood that the injured worker becomes a Medicare beneficiary as a result of age or disability increases.  The result, high prescription drug costs allocated in the Medicare Set-Aside (MSA) become a barrier to settlement of these legacy claims.

Tower has addressed this barrier through clinical interventions which have resulted in the majority of Tower’s CMS-approved MSAs containing no prescription drugs.  However, there remain legacy claims with high prescription drug spend which continue to stymie settlement.

Accordingly, Tower has partnered with the leading workers’ compensation pharmacy benefit manager, myMatrixx, to add its renowned clinical pharmacy team to the effort at breaking down the remaining barriers to settlement of these legacy claims.

What then can a PBM do to help with legacy claims?  How does a PBM work with an MSA company to settle these claims?

Tower is pleased to host a premier webinar panel with Phil Walls, RPh, Chief Clinical Officer for myMatrixx, and Dan Anders, Esq., Chief Compliance Officer for Tower on the following topics:

  • Define and quantify legacy claims with analytics
  • Identify factors driving up Rx costs in these claims
  • Explain how data can identify opportunities for clinical intervention
  • How to work effectively with PBM and MSA provider to reduce Rx and close claims
  • Provide examples/case scenarios demonstrating successful Rx intervention and settlement in legacy claims
  • Best practices for Rx management to prevent claims from becoming legacy claims

Please plan to attend the webinar on May 20 at 2 pm ET.

Thank you,

Dan Anders

Chief Compliance Officer