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?”
Entries by Jenevra Azzopardi, CPhT
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.
Calculating Days’ Supply – Pancreatic Enzymes
Auditors target pancreatic enzyme prescriptions like Creon® and Zenpep® due to high cost and ambiguous directions.
Signature Required – Proving Patient Receipt
The Public Health Emergency for COVID-19 ended on May 11, 2023, and PBMs notified pharmacies that they would once again be requiring signatures for proof of patient receipt of medications.
Automatic Prescription Refill Concerns
Many pharmacies use an automatic refill process to streamline the labor needed to fill prescriptions.
Are You Ready for Flu Shot Season? Auditors Are!
It is that time of year again; flu shot season is upon us. As busy as this season can be, we know you do not want to worry if you have all the documentation you need in case of an audit.
