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Skip to content Menu Close Search for: Menu Work Comp News Current News Daily News Archive Online School Employment Law News Podcasts Law Library About Contact Work Comp News Current News Daily News Archive Online School Employment Law News Podcasts Law Library About Contact Workers’ Compensation Daily News for November 17th, 2020 Amazon Launches Game Changing Online Pharmacy on November 17, 2020 at 10:27 AM A little over two years after its $753 million acquisition of the prescription medicine delivery service Pillpack, Amazon has finally launched Amazon Pharmacy , its online and mobile prescription medication ordering and fulfillment service. The launch of the new Pharmacy service within Amazon is a blow to other discount prescription services like the publicly traded GoodRx and companies like RxSaver and delivery services like ExactCare Pharmacy. The competition from Amazon was likely one reason why GoodRx began offering telemedicine services as a point of differentiation and to move up the value chain. It will be interesting to see if Amazon will also move to providing virtual care for more than its employees. Last year, the company rolled out Amazon Care for its workers in Seattle as part of a pilot service that provided both in-person and telemedicine services. Using a secure pharmacy profile, Amazon customers can add their insurance information, manage prescriptions and choose payment options all through Amazon’s service. And in another small push towards wider healthcare services, and not just selling items, users are provided with "self-service help" tools on Amazon’s portal, and they also have the option to speak to pharmacists either via over the phone, for advice: "Friendly and knowledgeable pharmacists are available 24/7 to answer questions about medications." After launching its own line of over-the-counter drugs in 2019, this is arguably Amazon’s broadest push into the healthcare business to-date , one that could open up very large, new revenue opportunities for the company, especially as the ongoing COVID-19 pandemic pushes consumers both toward more remote care, and using online channels for all their shopping needs. While Amazon Pharmacy looks to be a US-only launch for now, it’s a global opportunity. Online pharmacy services are projected to hit revenues of $131 billion by 2025 worldwide . Prescription drugs, meanwhile, have been estimated to be a $904 billion industry this year, growing to nearly $1.3 trillion by 2025. Amazon is also letting customers compare prices with their insurance co-pay, without insurance or with the savings available through the Prime prescription savings plan to choose the lowest option. Amazon is also staffing a pharmacy service accessible at all hours so that customers can answer questions about their medications. In August, Amazon launched its fitness tracker, Halo. The personal health and wellness monitoring and advice service includes a $64.99 wrist tracker and an application suite for monitoring health. Pfizer Starts COVID Vaccine Pilot Delivery Program on November 17, 2020 at 10:27 AM Pfizer has launched a pilot delivery program for its experimental COVID-19 vaccine in four U.S. states , as the U.S. drugmaker seeks to address distribution challenges facing its ultra-cold storage requirements. Pfizer’s vaccine , which was shown to be more than 90% effective in preventing COVID-19 based on initial data, must be shipped and stored at -70 degrees Celsius (minus 94°F) , significantly below the standard for vaccines of 2-8 degrees Celsius (36-46°F). "We are hopeful that results from this vaccine delivery pilot will serve as the model for other U.S. states and international governments, as they prepare to implement effective COVID-19 vaccine programs," Pfizer said in a statement on Monday. It picked Rhode Island, Texas, New Mexico, and Tennessee for the program after taking into account their differences in overall size, diversity of populations, immunization infrastructure, and need to reach individuals in varied urban and rural settings. The four states will not receive vaccine doses earlier than other states by virtue of the pilot, nor will they receive any differential consideration, Pfizer said. The company expects to have enough safety data on the vaccine from the ongoing large scale late-stage trials by the third week of November before proceeding to apply for emergency use authorization (EUA). Pfizer and its partner BioNTech SE 22UAy.F have a $1.95 billion deal to supply 100 million doses of the vaccine to the U.S. government, which has an option to acquire up to an additional 500 million doses. Earlier on Monday, rival Moderna Inc MRNA.O said its experimental vaccine was 94.5% effective in preventing COVID-19 based on interim data from a late-stage trial, boosting hopes that vaccines against the disease may be ready for use soon. Both the Pfizer and Moderna vaccines use a new technology called synthetic messenger RNA to activate the immune system against the virus. CMS Webinars Clarify WCMSA Appeal Process on November 16, 2020 at 8:36 AM This year, CMS has been quite active announcing several updates to its Medicare Secondary Payer Recovery Portal and holding a recent webinar on redetermination requests. CMS trends regarding post-settlement Total Payment Obligation to Claimant (TPOC) beneficiary recovery have been causing some challenges for workers’ compensation carriers from another angle. CMS will also be holding a webinar on the NGHP Beneficiary Recovery Process on December 9th . In September, CMS and the Commercial Repayment Center (CRC) held a webinar session to address "redetermination" requests as part of the administrative appeals process regarding conditional payment disputes of non-group health plans (NGHP). CMS reviewed the five levels of the administrative appeals process before the CRC discussed the various appeals available to primary payers in the administrative appeals process. The CRC outlined the specific arguments it will accept as part of a redetermination request as follows: -- Termination of Ongoing Responsibility for Medicals (ORM) due to benefits exhaustion; -- Termination of ORM due to settlement or other claim resolution; -- Benefits denied/revoked by applicable plan; -- Non-covered services; -- Unrelated services; and -- Duplicative primary payment. As part of this session, the CRC emphasized adherence to established appeal timelines and other related requirements is critical. On this point, the CRC advised redeterminations must be received within 120 days from the date a Medicare demand letter is received by the named debtor, which CRC noted is presumed to be five days after the date of demand. CMS’s trend of having the BCRC pursue the claimant post-settlement is currently causing some challenges and frustration particularly in workers’ compensation settlements . Specifically, the BCRC is increasingly opening conditional payment recovery cases upon receipt of TPOC information and issuing final demands with the claimant named the debtor . This occurs even in situations where the parties have previously worked with the CRC to resolve conditional payment cases related to ORM. When this happens, the carrier cannot interact with the BCRC on the claim without having a separate Proof of Representation (POR) executed by the claimant. This, in turn, complicates the workers’ compensation carrier’s ability to ensure that Medicare’s recovery is resolved if they cannot secure a POR from the claimant post-settlement. To prevent this, workers’ compensation carriers wishing to ensure conditional payment exposure is fully resolved may need to consider securing a POR from the claimant as part of the settlement process to avoid having to chase the claimant post-settlement for this required authorization. CMS has recently announced that it is holding a Non-Group Health Plan (NGHP) Beneficiary Recovery Process Webinar on December 9, 2020, at 1:00 p.m. ET . CMS indicates that its primary...