PBMs have dramatically increased the number of invoice audits conducted and some pharmacies continue to be at risk for significant financial recoupments and contract terminations.
About Jennifer Ottman, CPhT
I began working at an independent pharmacy in high school and really enjoyed being in the health care field. I provided clinical support to improve patient care and adherence to their medications. I have played a vital role in the pharmacy industry full-time for 23 years.
I have a Bachelor of Science degree from the University of Wisconsin-River Falls and have been a Certified Pharmacy Technician since 2001. Prior to joining the PAAS team, I was a floating technician, 3rd party district chargeback specialist, and district pharmacy training coordinator. Formerly, I was also an instructor for pharmacy technician certification classes.
PAAS’ personal, one-on-one connection will help your pharmacy become more successful in dealing with tiresome PBM audits. It is a pleasure knowing that my colleagues and I can help member pharmacies.
Entries by Jennifer Ottman, CPhT
Many of the denied claims are due to not meeting medical necessity, frequency limitations, lacking supporting medical records and even basic coding mistakes.
Spravato® is a Schedule III controlled substance intranasal spray used in conjunction with an oral antidepressant for treatment-resistant depression in adults
Ozempic® is an injectable diabetic medicine used to improve glycemic control in adults for type 2 diabetes management
Transferred prescriptions are at high risk for audit recoupment. The PBMs are hitting pharmacies on incomplete transferred prescriptions based on missing required elements.
PAAS National® has seen a few COVID-19 vaccine audits since pharmacies began billing and administering within the last few months. This article contains some reminders and updates from our January 2021 Newsline COVID-19 Vaccine Billing Guidance.
A PBM will recoup a claim in full if a medication is picked up after their required return to stock timeframes listed in the respective provider manuals.
Healthcare providers will play a key role when a COVID-19 vaccine becomes available.
PAAS National® has alerted members through several Newsline articles of an increase in audits with Prime Therapeutics®, Caremark®, OptumRx® and Express Scripts® investigating foot bath prescriptions.
Ozempic® is an injectable used to improve glycemic control in adults with type 2 diabetes mellitus and is available as 2 mg in a 1.5 mL (1.34 mg/mL) pre-filled, disposable pen injector.