The Office of Inspector General (OIG) announced a work plan being initiated for ‘bad actor’ pharmacies (previously identified by CMS or Part D Plan Sponsors) that continue to bill and receive payment for Part D drugs. OIG has concerns that existing CMS enforcement tools, such as revocation, preclusion, and payment suspension, may not effectively deter […]
As a quick reminder, CMS Form 10882 is a Medicare notice that Plan Sponsors (via CMS directive) require pharmacies to provide patients if a prescription copay for a Medicare Part D claim exceeds $600. The requirement to distribute CMS Form 10882 started January 1, 2025, and is prompted by an Approval Message Code 056. The […]
PAAS National®® alerted pharmacies to the launch of the first ‘generic’ GLP-1 receptor agonist, liraglutide, back in late June 2024. The product released was an Authorized Generic (AG) of Victoza®. In August 2025, another liraglutide product was approved and released to the market as an Abbreviated New Drug Application (ANDA) of Saxenda®. With this release […]
As part of the NCPA 340B task force, PAAS National®®® has advocated strongly that pharmacies should not be required to identify 340B claims. The individual claim’s status is typically unknown at the point of sale, and the process to update claims (N1 information exchange transactions), or reverse and rebill, is arduous. Not only is it […]
Record retention is an important topic pharmacies need to be on top of to ensure compliance. Although a large majority of prescriptions filled by pharmacies are now electronic, other methods such as telephone orders, transfers, faxes, and written hard copies have not been completely wiped from practice. It’s understandable that a pharmacy may be looking […]
PAAS National®® analysts continue to see unbreakable packages on audits causing recoupment due to dispensing quantity and days’ supply issues. Below is a list of common scenarios: Pharmacies should always …
PBMs and audit companies pay close attention to how pharmacies bill claims, including which DAW code was used. This seemingly innocent billing element can cause significant audit issues if not used properly. Any DAW (other than 0) should have supporting documentation for why it was appropriate to use. PBMs will continue to pay close attention […]
Filing and billing claims involves keeping track of what can feel like an endless number of details. The fast-paced environment of the pharmacy doesn’t always allow for keeping tedious details at the forefront of your mind. Below you’ll find a guide detailing common scenarios that should be considered while filling prescriptions to reduce your audit […]
CMS Form 10882 is a Medicare notice that Plan Sponsors (via CMS directive) require pharmacies to provide to patients if a prescription copay for a Medicare Part D claim exceeds $600. This distribution requirement started January 1, 2025, and is prompted by an Approval Message Code 056. The expiration date on the current version of […]
Abbott has announced that the FreeStyle Libre 2 and FreeStyle Libre 3 sensors will no longer be available after September 30, 2025. Patients that are currently filling prescriptions for these products will need to obtain new prescriptions for the FreeStyle Libre 2 Plus or FreeStyle Libre 3 Plus sensors. FreeStyle Libre 2 Plus sensors can […]
