Bowel Prep Products – What Quantity and Days’ Supply to Bill?

PAAS National® last wrote an article on bowel prep products in June 2022 titled Bowel Prep Products – Days’ Supply Considerations. Since then, a few new products have been approved and added to the market. The most common PBM audit issue PAAS sees with bowel prep products is billing an incorrect days’ supply.

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Product NCPDP Quantity Beyond-Use Date
CLENPIQ® 320 mL n/a
GoLYTELY® 4000 mL 48 hours after mixing
MoviPrep® 1 EA 24 hours after mixing
SUFLAVE™ 2 EA 24 hours after mixing
SUPREP® 354 mL n/a
SUTAB® 24 EA n/a

PAAS Tips:

  • Make sure you are billing the correct quantity – some are billed in mL and some as EA
  • Bowel prep products should be billed as 1- or 2-day supply, depending on the dosing schedule
    • PBMs will often flag claims that have been billed as a 30-day supply due to the beyond-use dating of these products
  • If the prescription is written “Use as Directed”, PAAS suggests contacting the prescriber to find out if the patient is to follow the package directions or if the prescriber had directed the patient to take it in a different manner. The pharmacy can also verify the directions if the patient has instruction sheets
  • Once clarified, document a clinical note on the prescription and update the patient’s label with the specific directions or “use as directed per package” and bill the appropriate 1- or 2-day supply
  • Beware – if the prescription instructions for use indicated chronic/maintenance dosing (e.g., 30 days or includes refills), clarify indication and confirm that there was no order entry error
    • Prescriber may have intended MiraLAX® which also has polyethylene glycol 3350 and is intended for chronic treatment; mixed one capful at a time, there is no meaningful beyond-use date to consider

Jennifer Ottman, CPhT