PBM Audits: Letters to Patients for Prescription Verification
Pharmacies often see PBM audit letters requesting documentation to validate paid claims, but not very many see letters sent to their patients.
Entries by Eric Hartkopf, PharmD
Specialty Pharmacy Paying the Price: $20 Million Settlement for Kickbacks and Copay Waivers
A September 30, 2023, Department of Justice press release outlined a recent settlement between the U.S. government and a specialty pharmacy based in Delaware.
Advances in Respiratory Syncytial Virus (RSV) Prevention
There are two RSV vaccines FDA-approved for people ages 60 years and older – AbrysvoTM and Arexvy®.
OTC COVID-19 Test Prescribing Authority
Some pharmacies are wondering if they are allowed to continue prescribing OTC COVID-19 tests.
Use As Directed – What is Your Attack Plan?
The top audit discrepancy year after year is invalid days’ supply or refill too soon – which are essentially the same issue.
Caremark Invoice Audits – Pharmacy to Pharmacy Purchases
PAAS National® continues to see PBM audits increase as we get further out from the formal end of the COVID-19 Public Health Emergency. One disturbing trend is the number of invoice audits, particularly from Caremark.
Considerations With Ozempic 0.25 Weekly
PAAS National® analysts receive many questions on Ozempic® relating to concerns about off label use; however, we also receive questions about what days’ supply to submit on claims – particularly for initiation dosing.
Desk Audits for Worker’s Compensation Claims
PAAS National® analysts have recently seen an increase in desk audits for worker’s compensation claims, mostly performed by Script Care.
Invoice Audits Are on the Rise – Are You Prepared for Success?
Most pharmacies have grown accustomed to desk audits and providing copies of prescriptions, signature logs, and even copay collection records to PBMs upon request. Additionally, many pharmacies can recount their most recent experience with an onsite auditor visiting their pharmacy and the numerous questions related to operations, policies & procedures, and credentialing. However, not as many pharmacies have experienced an invoice audit – the stakes are higher and honest mistakes can lead to very expensive lessons in the process.
Are You Missing Audit Communications?
PAAS National® analysts have recently seen many PBMs and audit contractors send communications, including audit letters, to network pharmacies via email instead of facsimile or postal mail.
