Pharmacies have sent PAAS National®® notices from Caremark entitled “CVS Caremark Rx Claim Review.” The first line of the notice says, “This communication is for educational purposes only and is not part of an audit.” This has led to many questions and confusion amongst the pharmacies receiving these notices. PAAS has seen waves of these […]
Analysts at PAAS National®® assist with invoice audits on a daily basis. While not as common (in number) as desk audits, the implications of bad audit results are high and can be challenging to appeal. Often questions come up asking why it matters if the exact NDC is billed? A few recent cases from the […]
For independent pharmacies, invoice audits continue to gain traction by the PBMs. While the recently announced WAC decreases make bulk purchasing a potentially precarious scenario, one PBMs also has rigid requirements for “bulk purchasing”.
Successful pharmacies recognize the immense value of team members who are dedicated, diligent, knowledgeable, and reliable. With the financial squeeze in community pharmacies, payroll can be a tough spot to spend extra money. Having the employee fill prescriptions at the pharmacy they work in, and not having them pay the resulting copay, can be a […]
Pharmacies across the country are receiving a second notice from AstraZeneca regarding Farxiga® discrepancies. As before, there are two versions of this letter but now AstraZeneca is asking pharmacies for specific information and actions.
Across the country, health care fraud affects all areas of the healthcare system, but how does it affect your pharmacy? Bad actors in pharmacy give validation to PBM audit practices, adding to the audit burden. PBMs leverage these audits as a method to keep the “bad actors” out of the health care field and save […]
Community pharmacies are always looking for ways to provide better care for patients. A primary focus continues to be on customer service – whether it be cost savings on prescriptions, convenience of delivery or med-sync programs. When a patient presents to the pharmacy with a new prescription, the focus is on education and adherence. Wouldn’t […]
Many pharmacies that PAAS National®® assists with audits have similar sentiments, “Why us?” or “We just had an audit with [insert PBM here]”. It can feel like it is a never-ending cycle, with shifting standards depending on which PBM is conducting the audit. At PAAS, we understand these concerns — and we’re here to help. […]
While PAAS National®® sees a vast array of PBM audits daily, did you know that claims billed to a manufacturer coupon can also be audited by the coupon administrator? Each manufacturer coupon…
A Florida-based pharmacy plead guilty to healthcare fraud and agreed to pay over $1 million to resolve False Claims Act violations stemming from falsified prior authorizations. The pharmacy dispensed Evzio® (injectable naloxone product for emergency treatment of opioid overdose—discontinued in October 2020) which frequently required prior authorizations due to its high cost. Instead of sending […]
