Could You Be Giving Vaginal Creams Away for Free?
PAAS National® analysts continue to see claims for Premarin® and Estrace® creams being audited and recouped. Are you in jeopardy?
Entries by Dana Westberg, CPhT
Is Your Pharmacy Ready for an Unannounced Audit?
Pharmacies are often startled with the limited amount of time a PBM offers prior to an onsite audit. However, PBM auditors, DEA agents, FDA inspectors and state Board of Pharmacy inspectors can also make unannounced visits.
New Dispensing Platform? Be Ready in Case of an Audit!
Pharmacies updating or changing their dispensing platform may face unique audit issues.
Yes, OTC COVID-19 Tests Can Be Audited!
Dispensing OTC COVID-19 tests is widespread through community pharmacies. Pharmacies must be aware that submitting claims to PBMs for these tests opens the window for auditing. Ensuring you have procedures in place to accurately purchase, bill and dispense these home tests is imperative. While the dollar amount of these claims does not seem audit worthy, PBMs will be checking for Fraud, Waste and Abuse and contract violations.
Insulin for a Pump – Medicare B or Medicare D?
Be sure you know how to correctly bill your patients’ insulin.
Beware and Be Ready! In-Person Onsite Audits Are Resuming
OptumRx and Express Scripts recently sent notices to pharmacies informing them in-person onsite audits will be starting back up in April.
Caremark® Turns Up the Heat on Proof of Copay Collection Requests
PAAS National® is seeing a rising number of Caremark® audits requesting proof of copay collection. This requested information may be included in a desk, virtual onsite, or invoice audit. The number of claims requested can range from just a few claims to all dates of fill for several prescriptions.
Transfer Prescriptions Continue to Be Targeted
Transferred prescriptions remain a common audit target, and pharmacies are facing recoupments due to missing information.
Don’t Jump the Gun: Refill Too Soon Recoupments
Pharmacies know the importance of billing accurate days’ supply on prescriptions; however, there may be circumstances that can make this challenging.
Updated PAAS National® Dispense In Original Container Chart
Dispensing medications outside of FDA packaging requirements may put your claims at risk of recoupment. Medications sensitive to light and/or moisture may require pharmacies to dispense the medication in the original container.
