Proper Billing of Nayzilam® and Valtoco® Nasal Sprays
If your patient is prescribed Nayzilam® or Valtoco®, the perplexing billing opens the door for easy recoupments from PBMs.
Entries by Meredith Thiede, PharmD
Missing PBM Audit Notifications: How Are They Supposedly Sent?
At times, pharmacies fail to receive audit notifications, even though PBMs record them as “successfully” delivered. Thus, understanding how PBMs communicate with pharmacies can be beneficial.
Audit Risk: Billing DAW 1 Unnecessarily
In a time where every aspect of prescriptions is scrutinized, PAAS National® wants to ensure you don’t forget simple filling and billing practices; in this case, using DAW 1 appropriately.
Philadelphia Pharmacy Employees Charged for Drug Diversion and Fraudulent Billing Practices
A years-long investigation of the top retail pharmacy purchasing oxycodone in Pennsylvania has come to resolution.
Does My Pharmacy Really Need Cultural Competency Training?
Pharmacies are no stranger to the requirements of completing annual Medicare Fraud, Waste, and Abuse training, which is a very clear requirement created by Medicare Part D and MAPD statutes. Because CMS holds PDPs and MAPDs responsible, PBMs often ask for the pharmacy’s FWA training during onsite audits. On the contrary, cultural competency training isn’t something PBMs regularly ask for. In a world where pharmacy employees are already spread thin, is completing cultural competency training truly necessary?
2023 Health and Human Services Language Access Plan Released: New Plan, Same Goal
Equal access to health care is far from a new topic, dating back to Title VI of the Civil Rights Act of 1964. In recent years, there has been a noticeable increase in enforcement.
New COVID-19 Booster Dose & The Final Frontier of the PREP Act
On February 28th, the CDC endorsed an additional updated 2023-2024 COVID-19 vaccine dose for adults 65 years or older due to the increased risk of serious COVID-19 outcomes in that patient population.
Best Practices When Filling & Billing Afrezza®
Afrezza®, a rapid-acting insulin human inhalation powder for adults with either type 1 or type 2 diabetes mellitus, can cause confusion for prescribers, pharmacies, and patients alike.
Best Practices for DAW Billing in Pharmacies
In what should be a fairly straightforward process, proper DAW billing practices can be convoluted. Despite NCPDP guidance to standardize adjudication practices, PBMs do not always adopted these standards, leaving the pharmacy in a gray area of what proper DAW billing should look like.
Don’t Cut Corners: Notations on Prescriptions
Not only are new medications frequently released to market, but also new strengths and formulations of existing medications.
