Although Utilization Reviews (URs) and Independent Medical Reviews (IMRs) have been used in state jurisdictions for years, insurers have only recently focused on how the Centers for Medicare and Medicaid Services (CMS) treats URs and IMRs when evaluating Medicare Set-Asides (MSAs).
On January 26, 2015, the FDA approved esomeprazole, the generic form of Nexium. Claims payers and the Medicare Set-Aside (MSA) industry take notice any time a widely prescribed brand-name drug becomes available as a generic. The impact of generic availability, if not immediate, can eventually prove to be dramatic.