Oral Inhalers – What You Need to Know About Institutional Pack Sizes
Oral inhaler prescriptions are frequently targeted for audit by PBMs because of their cost, frequent billing errors (e.g., incorrect days’ supply), or prescribing errors (e.g., non-mathematically calculable directions or incorrect written quantity). Vague written quantities can cause recoupments when multiple package sizes exist, including institutional package sizes.
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Institutional size packages primarily exist to allow pharmacies to dispense a smaller package for acute care and institutional settings. The existence of these products can cause audit discrepancies when a prescription is written for a quantity of “1 inhaler” or “1 unspecified.” Many retail pharmacies have expressed to PAAS National® that they cannot order the institutional size packages, so they assume billing one inhaler at the retail quantity is sufficient – auditors disagree. If multiple package sizes exist (including institutional size packages), an auditor will insist that they do not know what quantity the prescriber intended and require you to obtain a prescriber statement clarifying the quantity on appeal.
How can you preemptively avoid this situation? PAAS has updated our Oral Inhalers Chart to include a column for institutional size packages and their billing units. Train your technicians to look closely at the written quantity on the prescription. Does it make sense for the package size being dispensed? If the quantity is written for “1 inhaler,” is there an institutional size package or an additional package size to be considered? Clarify any incorrect, unspecified or ambiguous quantities with the prescriber and document a clinical note on the prescription prior to dispensing.
PAAS Tips:
- Written quantities on a prescription should contain the proper billing unit of measure (UOM) per NCPDP guidelines, especially if multiple package sizes exist
- Pay close attention to electronic prescription quantities which have the biggest potential for incorrect or “unspecified” UOM
- Other prescription origins (written, fax, and transfer) may need clarification for missing UOM
- Notating UOM on all telephone orders would be considered the best practice
- Clinical notes should contain the date, the name and title of who you spoke with, a summary of your discussion, and your initials
- Download the Oral Inhalers chart for the information on package sizes and other useful information like number of puffs per package, beyond use dates, and days’ supply calculations
- Review our December 2024 Newsline article, 2024 Self-Audit Series #10: Nasal and Oral Inhaler Prescriptions, for more tips on audit-proofing your oral inhalers
I have a Bachelor of Arts in Communications from the University of Wisconsin – Madison. Prior to joining PAAS in 2017, I worked for Walgreens for 19 years.
As an Analyst at PAAS, I really enjoy being able to help independent pharmacies succeed. I have always been a fan of the underdog and am excited to be able to give you the tools you need to take on the giants of the PBM industry.
