Bill It Right – Diazepam Gel

Diazepam rectal gel continues to confuse prescribers and pharmacies alike when it comes to how a prescription is written and then ultimately filled and billed. According to FDA labeling, this medication “is intended for the acute treatment of intermittent, stereotypic episodes of frequent seizure activity (i.e., seizure clusters, acute repetitive seizures) that are distinct from a patient’s usual seizure pattern in patients with epilepsy 2 years of age and older.”

Diazepam gel comes in three strengths: 2.5 mg, 10 mg (5-7.5-10 mg), and 20 mg (12.5-15-17.5-20 mg). Each box contains two doses and is billed as “1 each.” The standard dosing for diazepam gel is one dose for appropriate seizure activity and repeat 4 to 12 hours later if prescribed. The FDA recommends that diazepam rectal gel be used to treat no more than five episodes per month and no more than one episode every five days, therefore one package should be considered a 5-day supply at minimum.

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  • If a quantity is unclear, verify it with the prescriber and make a clinical note
    • If a prescriber writes for a quantity of “2,” do they mean 2 doses (1 box) or 2 boxes (4 doses)?
    • Most PBM audit enforcement of this medication revolves around quantity errors
  • One box is 2 doses but billed as “1 each”
  • Suggested days’ supply for one box is 5 based on FDA dosing recommendations
  • Use caution and clinical common sense when filling refills
    • Do not place this medication, or any emergency/rescue medication, on auto-refill
    • Auditors track refill history which may open you up to audits if filling emergency/rescue medications at a higher rate than other pharmacies
  • See September 2020 Newsline article, Suggested Days’ Supply for Emergency Medications for other frequent audit targets
Jenevra Azzopardi, CPhT
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