Entries by Meredith Thiede, PharmD

PBM Provider Manual Updates – What You Need to Know

Pharmacy Benefit Managers (PBMs) update their provider manuals on occasion (some more frequently than others) and although the changes are applicable to the practice of all pharmacies contracted with that PBM, it can be difficult to keep track of the method by which each PBM updates their manual and where to find it.

Vaccinating Outside of Approved COVID-19 Emergency Use Authorization Has Legal Ramifications

As reported in a September 27, 2021 article by the US Attorney’s Office, the owner of a pharmacy in Juana Díaz, Puerto Rico, “knowingly and willfully” administered vaccine outside of the Emergency Use Authorization (EUA) and subsequently billed Medicaid for the claims. Twenty-four children between 7-11 years of age were vaccinated with the Pfizer-BioNTech COVID-19 vaccine.

Humana Audit Program Updates

On July 1, 2021 Humana updated three audit program documents and published them on their public pharmacy resources page under the “Manuals and forms: Audit guide, claim form and other materials” tab section.

PHI Access and Release for Deceased Patients

According to the Office for Civil Rights (OCR), the Privacy Rule allows for pharmacies to disclose PHI about a deceased patient to person(s) involved in the individual’s health care prior to their death, unless doing so is going against the patient’s documented requests.