Required: Proof of Patient Copay Collection
All PBM agreements contain language requiring pharmacies to collect copays and be able to prove those copays were collected if audited.
Entries by Jenevra Azzopardi, CPhT
2024 DMEPOS Series #2: Nebulizer Solutions
Many pharmacies struggle with DMEPOS audits due to the complexity in medical billing and the onerous documentation requirements.
Early Refills of Titrated Medications Lead to Recoupments
Titration is a common practice for certain medications where prescribers start a patient on a low dose and gradually increase the amount over time to find what’s most effective.
2024 DMEPOS Series #1: Diabetic Test Strips
Many pharmacies struggle with DMEPOS audits due to the complexity in medical billing and the onerous documentation requirements.
Addressing “Weird” Days’ Supply
e know that days’ supply should be billed based on the mathematically calculable directions, but what happens when the days’ supply does not fall in the easily calculable 30- or 90-day spectrum? What if it is “weird?”
Adapting to Change: Levemir® Phase Out and Its Implications for Pharmacies
In November 2023, Novo Nordisk® announced that it would be phasing out the company’s long-acting insulin, Levemir®, in the United States.
Painful Lessons: What You Should Know About Return to Stock Timeframes
PBMs allow a limited amount of time for a prescription to be picked up or delivered to a patient before the claim must be reversed and the medication placed back into the pharmacy’s stock inventory.
Transfer Tragedy: A Timeworn PBM Target
It’s a tale almost as old as time – a patient’s medication is sent to one pharmacy only to have the patient decide they want it filled by your pharmacy instead.
Avoiding MedImpact Recoupments for Bypassing Plan Limits
Pharmacies receive many rejections while billing claims throughout the day. Paying attention to these rejection messages is key to avoiding audit recoupments, which may occur years later.
Documentation Deep Dive: Meeting Auditors’ Standards in DUR and SCC
PAAS National® frequently sees claims audited that contain a clinical drug utilization review (DUR) or submission clarification code (SCC), particularly from Express Scripts and Prime Therapeutics.
