Combivent® Respimat® Still Causing Confusion

In 2013, Combivent® Inhalation Aerosol inhalers made by Boehringer Ingelheim Pharmaceuticals were discontinued and phased out because they contained chlorofluorocarbons or CFCs (harmful substances that work to decrease the ozone layer above the Earth). The original Combivent® inhaler was then replaced by Combivent® Respimat®.

The new inhaler was not an exact replacement of the old one. The original Combivent® inhaler (14.7 g) had dosing of two inhalations four times a day with the total number of inhalations not to exceed 12 puffs in 24 hours. The updated Combivent® Respimat® (4 g) has a recommended dosage of only ONE puff four times a day with a total number of inhalations not to exceed 6 puffs in 24 hours.

This dosing change has caused problems for pharmacies over the years. Prescribers have been known to still send prescriptions to the pharmacy with the old directions. If the pharmacy fails to clarify the directions, patient safety could be a concern and the claim is sure to be flagged for audit.

Another problem PAAS National® has seen is related to billing the correct days’ supply on a claim. Combivent® Respimat® contains 120 metered doses. If a prescription is written for one puff four times a day, then the days’ supply is 30. If the prescription notes the patient may take up to 6 puffs per day, then the days’ supply is 20.

What happens if the plan will not allow a 20-day supply? The first instinct of many pharmacies is to rebill the claim as a 30-day supply, but this would be incorrect and would likely flag for an audit. The insurance company will see you originally tried to bill a 20-day supply and will want to know why it was changed. This may be interpreted as claims data manipulation and a circumvention of the plan limits. The proper thing to do in this case is follow any reject instructions, possibly obtaining a prior authorization for the correct dosing. See our January 2022 Newsline, Manipulating Quantity or Days’ Supply to Bypass Plan Limits Will Cost You, for further information.

PAAS Tips:

Become an audit assistance member today to continue reading this article. As a member, you’ll have access to hundreds of articles and receive our monthly proactive newsletter!

Join today!

Did you know there is much more to your audit assistance membership than just help with audits? The PAAS Member Portal contains a wealth of information and resources to assist you with audits and member service questions. Below is a list of 6 pages found on the Audit Assistance section of the PAAS Member Portal to assist you and your pharmacy staff to be proactive when it comes to audits.

  • Access Services
    • Audit Documentation Submission Guidance
    • An online form to submit safe filling and billing questions
    • Your PAAS Membership Manual
  • Newsline
    • Monthly newsletter articles, written by our expert PAAS analyst team, provide safe filling and billing tips and relays relevant/current PBM trends to be help prevent audits
    • Search the Newsline Archive to get PAAS tips at the click of a button
    • Special Edition Newslines including: Top 10 articles of the prior year, DMEPOS Article Series and a Self-Audit Article Series
    • Ability to print monthly issues or individual articles
  • Proactive Tips
    • Audit flags – list of various claim attributes the PBMs use to select claims for audit
    • Billing insulin vials – flowchart to assist whether you should bill Medicare Part B vs Part D
    • DAW Codes Explained – use to understand when to effectively use DAW codes, their definitions and why claims may be flagged for audit if a DAW code is used incorrectly
    • Basic DMEPOS documentation guidance
    • Onsite Credentialing Checklist and expanded definitions of policies and procedures
    • Proof of refill request and affirmative response form for DMEPOS items
    • Steps on how to prepare for an onsite audit
    • And more!
  • Days’ Supply Charts
    • Utilize the days’ supply charts for inhalers, insulins, nasal sprays, eye drops and topicals to aid you in calculating the correct days’ supply
    • Guidance on overbilled quantities and incorrect days’ supply account for a sizable portion of audit chargebacks
    • Additional miscellaneous charts, which include: Dispense in Original Container and Return to Stock
  • Forms
    • Signature Logbook for print
    • Signature Trifold Mailer
    • Fax and Email Coversheet
    • Patient Attestation for over-the-counter COVID-19 test kits
  • On-Demand Webinars
    • Short webinars on hot topics in the PBM industry. Here are a few examples:
      • USP 800 Compliance
      • Cultural Competency Training
      • Dispensing Prescriptions Off-Label
      • Biologic Medications and Interchangeability
      • Continuous Glucose Monitor Requirements for Medicare Part B

PAAS Tips:

  • MORE AUDITS, MORE INSIGHT – PAAS National® is the industry-leading defender of community pharmacy dealings with Prescription Benefit Programs, including Caremark, Express Scripts, Humana, Medicaid, OptumRx, Prime Therapeutics., and more. PAAS assists on all third-party audits, including: desktop audits, onsite audits, invoice audits, OIG/Medicaid audits, Medicare B audits. The PAAS team is dedicated to helping you! We have five pharmacists and a complement of technician analysts with over 50 years of dedicated audit assistance experience. PAAS continuously updates their database with every audit received — in fact, we even keep a scorecard on individual auditors.
  • Get answers to your questions on days’ supply calculations, drug substitutions, billing practices, required documentation, prior authorization requirements, record retention, and internal audit procedures – just to name a few. As a trusted partner, we will provide tailored guidance to help you proactively prevent audits. Remember, the prescription claims you submit today are the audits of the future.
  • Keep your employees engaged and help lower audit risk by adding all employees to the portal and giving them permission to access these tools, resources and eNewsline. For more information review September 2019 Newsline article, What Are You Waiting For? Make Sure ALL of Your Employees are Added to the PAAS Portal!
  • Contact PAAS at (608) 873-1342, if you would like a tour of your PAAS Member Portal, so you can reap all the benefits of your PAAS Audit Assistance. We appreciate you being a member.
Jenevra Azzopardi, CPhT
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