Entries by Eric Hartkopf, PharmD

Caremark Manufacturer Coupon Policy

PAAS National® continues to see pharmacies suffer full recoupment on claims that are processed to coupons and copay cards in violation of Caremark’s policy found in section 3.03.03 of the 2020 Pharmacy Provider Manual.

BEWARE: Virtual On-Site Audits Are Coming!

If you haven’t already noticed, most of the PBMs have resumed auditing practices and started issuing on-site audits the first week of August; however, these are not the on-site audits that you are used to.

Caremark Enforcement: Aberrant Quantities & Volumes

PAAS is starting to see Caremark enforce their new policy about Aberrant Quantities and Volume that we first wrote about in a December 2019 article Important: Caremark Provider Manual Updates for 2020!.

PBMs Enforcing Return to Stock Policies

It is common practice for PBMs to recoup claims [in full] for medications being picked up after the return to stock timeframes listed in their provider manuals (also known as “unclaimed prescriptions”). Pharmacies with an integrated Point-of-Sale should look to generate a list of prescriptions near the allowed timespan for medications to be left in pick-up bins.