Copays for Pharmacy Staff and Family

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.

PAAS Tips:

• 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