PAAS National® analysts occasionally field questions related to copay collection, particularly with respect to prescriptions for pharmacy employees and their families. While it is certainly most convenient to fill prescriptions at the pharmacy you spend 8-10 hours at every day, it is important to make sure that copay amounts due are collected and documented.
We frequently see PBM audits request documentation such as prescription copies and proof of copay collection for pharmacy employees – they are looking for pharmacies that may be cutting corners on documentation, billing claims where a valid prescription does not exist, or waiving copays as an employee benefit.
Please consider the PAAS tips below to avoid PBM audit problems.
- Pharmacies must collect (and document) copays for employees and their families
- Do not discount or waive copays in an attempt to provide an “employee benefit” to staff
- If prescription copays are not collected at point-of-sale, then be sure that you have a bona fide process to track amounts due and payments subsequently received
- Be alert that employee prescriptions are subject to extra scrutiny