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March 23, 2016 - Press Release
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Contact:  Brian S. Bailey, Executive Director
Office: (855) 677-2776 (MSA-ASSN)
275 N. York Street, Suite 401
Elmhurst, IL 60126-2752



NAMSAP Proposes Evidence-Based Limits on Opioids
For Workers’ Compensation Medicare Set-Aside Arrangements

Elmhurst, IL, March 23, 2016: 
National attention is finally being paid to the opioid epidemic in the United States, as we experience the catastrophic impact of the robust marketing of those drugs on Americans for treating chronic, non-malignant diagnoses such as back pain and arthritis since the 1990’s. The National Alliance of Medicare Set-Aside Professionals (NAMSAP) is leading the charge on limiting opioid usage by requesting that the Centers for Medicare and Medicaid Services (CMS) cap costs earmarked for future opioid expenditures, thereby seeking to reduce ongoing usage of these dangerous medications.

According to the January 1, 2016 Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report, approximately 47,000 deaths in 2014 were related to overdoses from opioid pain relievers and heroin[1]. This figure represents a 6.5 percent increase from the opioid overdose deaths reported in 2013. In an effort to address this issue, the Food and Drug Administration (FDA) re-classified opioids as Schedule II drugs. President Obama also highlighted the problem in the opening minutes of his State of the Union address to Congress this year. Rather than relying solely on physicians to rectify the problem, most states are taking legislative action to counteract the life-threatening effects of opioid abuse, by taking proactive steps to place caps on and limit the prescription of opioids for chronic benign pain altogether. According to a recent article in the New York Times, there are currently about 375 proposals in state legislatures to regulate pain clinics and aspects of painkiller prescriptions[2]. In addition, criminal charges are finally being brought against medical providers who repeatedly ignore the science and prescribe lethal doses of opioids. Despite all this attention, opioid over-prescription, addiction, overdose and death continue to ravage our population.

Evidence-based studies have long shown that long-term use of opioid medications for chronic, non-cancer pain is ineffective, counterproductive and, if left unchecked, deadly. 90% of chronic pain is not effectively treated with opioids, and opioid use for chronic pain is not associated with any increase in function. Using opioids for more than seven days doubles the risk of disability at one year. Every patient who is chronically prescribed opioids will develop dependence, and 60%  of those prescribed opioids for more than three months, will still be on opioids in five years[3] [4]. Knowing this, shouldn’t the workers’ compensation industry, WCMSA vendors and CMS work together to be a part of a solution to this epidemic, rather than promote it?

Medicare Set-Asides (MSA) are meant to ensure that settlements do not inappropriately shift the burden of injury-related, future medical expenses to the Medicare system. Medicare only has an interest in post-settlement items that are both compensable under state law and covered by Medicare. CMS’ own opioid overutilization policy recommends Part D sponsors lower their safety edits to set red flags for beneficiaries taking a 120mg MED daily dose for more than 90 days and with prescriptions from more than three prescribers/pharmacies. Stricter limits are currently being re-examined by CMS in its 2017 Draft Call Letter to further reduce unsafe overutilization of opioids. Patients aged 65 and over, Medicare’s largest population, are more susceptible to accumulation of opioids, cognitive impairment, respiratory depression and overdose[5]. So why do WCMSA approvals often include future prescription allocations with Morphine Equivalent Dosages in excess of 120, 200 or even 500 per day, over the beneficiary’s full life expectancy?  And what message does a WCMSA supporting these high opioid dosages over a patient’s entire life expectancy send to the addicted patient?

Medical literature shows a 12 time increased risk for death from overdose when taking more than 40mg MED per day[6]. Absent solid science to support the use of these drugs, continuation is unjustified.

NAMSAP is confident that by working together with CMS to combat excessive opioid allocations in WCMSA’s, patient safety will be enhanced. In order to facilitate this, NAMSAP supports the following:

  1. A hard cap of 90 MED based on CDC guidelines for no more than one month when the WCMSA includes a surgical projection; and/or,
  2. A hard cap of 40 MED for no more than one month, followed by a 10% per week mandatory tapering and weaning plan, as recommended by the CDC, until fully weaned from opioids[7].


The National Alliance of Medicare Set-Aside Professionals (NAMSAP) is the only non-profit association exclusively addressing the issues and challenges of the Medicare Secondary Payer Statute and its impact on workers’ compensation and liability settlements. Through the voluntary efforts of our members, NAMSAP is a forum for the exchange of ideas and is a leading resource for information and news in this constantly evolving area of practice. The collective knowledge of our members and NAMSAP’s resources will provide attorneys, nurses, settlement planners, claims professionals, and others with the ingredients essential to their success.




[1] “Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014.” Morbidity and Mortality Weekly Reports (MMWR). Centers for Disease Control and Prevention (CDC). January 1, 2016. Accessed at:

[2] “States Move to Control How Painkillers Are Prescribed.” B. Meier & S. Tavernise. The New York Times. March 11, 2016. Accessed at:

[3] “Safely Prescribing Opioids in Practice.” G. Franklin. American Academy of Neurology (AAN). Course C171-Opioids and Marijuana in Your Practice. April 19, 2015. Accessed at:

[4] “Long-Term Chronic Opioid Therapy Discontinuation Rates from the TROUP Study.” B. C. Martin, et al. Journal of General Internal Medicine. (12):1450-7. December 2011. Accessed at:

[5] “Management of Opioid Analgesic Overdose.” E. W. Boyer. New England Journal of Medicine. 367(2): 146–155. July 12, 2012. Accessed at:

[6] “A history of being prescribed controlled substances and risk of drug overdose death.” L. J. Paulozzi, et al. Pain Medicine. 13(1):87-95. January 2012. Accessed at:

[7] “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016” D. Dowell, et al. Morbidity and Mortality Weekly Reports (MMWR). Centers for Disease Control and Prevention (CDC). March 18, 2016. Accessed at:

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