Best Practices for Dispensing GLP-1 Medications and Reducing Recoupment Risk
Pharmacies continue to see a large number of prescriptions for GLP-1 medications like Ozempic and Mounjaro and have concerns about the risk of PBM audits and recoupments.
Entries by Eric Hartkopf, PharmD
Caremark Memo: Novolog® and Novolin® ReliOn®
PAAS National® frequently gets questions about whether pharmacies may substitute various medications and if such substitutions require the approval of the prescriber.
Biologic Drug Substitution Best Practices (Update)
PAAS National® frequently gets questions about whether pharmacies may substitute various medications and if such substitutions require the approval of the prescriber.
Caremark Resumes Signature Log Requirements Effective May 12, 2023
Caremark issued a Pharmacy Update memo on March 8, 2023, stating that they would resume signature log requirements for audits effective May 12, 2023.
Express Scripts Provider Manual – 2023 Updates
All PBMs update their Provider Manuals at regular intervals and Express Scripts (ESI) is no exception.
Medicare Caps Copay for Insulin at $35 per Month
As most of you (and your Medicare patients) have undoubtedly noticed, Medicare has applied a $35 per month cap on copays for insulin prescriptions ($105 for a 3-month supply) for years 2023-2025.
Ozempic and Mounjaro Prescriptions – Between a Rock and a Hard Place
Many pharmacies continue to receive new prescriptions from patients eager to start on therapy for Ozempic and Mounjaro.
2022 CVS Caremark Provider Manual Supplement for 2023
Caremark has released the 2022 CVS Caremark Provider Manual Supplement which is effective January 1, 2023.
Essential Elements of Corrective Action Plans
PAAS National® analysts have recently seen an increased number of PBM audits with “significant” results, including a large number of unique issues, large dollar amounts (>$100,000) or both. Audits of this magnitude may trigger further consequences such as additional audits, payment suspension and/or threat of network termination.
Medicare Extends Part B Coverage for Kidney Transplant Drugs
Patients with Medicare because of End-Stage Renal Disease (ESRD) currently lose coverage 36 months after a kidney transplant unless otherwise eligible for Medicare.
