November 15, 2013 – Notice of Barbiturate Coverage Changes in Medicare Part D Effective for WCMSA Proposals Submitted on or after January 1, 2014
Barbiturate coverage under the Medicare Part D Benefit will be changing on January 1, 2014. Due to the passage of the Patient Protection and Affordable Care Act (PPACA), all restrictions on barbiturate indications will be lifted and any medically accepted indication will have coverage under the Medicare Part D Benefit. (Refer to the Patient Protection and Affordable Care Act (PPACA). Sec. 2502. Elimination of Exclusion of Coverage of Certain Drugs. June 9, 2010.)
Effective January 1, 2014, CMS will begin allocating barbiturates for all medically accepted indications within WCMSAs. Barbiturates are currently limited to the treatment of epilepsy, cancer, or a chronic mental health disorder (as found in the Medicare Improvements for Patients and Providers Act (MIPPA)).
Please note that WCMSA cases submitted to CMS before January 1, 2014, closed due to missing, incomplete and/or inadequate supporting documentation (or any other reason), and subsequently re-opened after January 1, 2014, will also be subject to a review that includes the Barbiturate coverage changes due to PPACA.