PAAS National® analysts continue to see claims for Premarin® and Estrace® creams being audited and recouped. Pharmacies not calculating the accurate days’ supply are in jeopardy of refilling too soon. These early refills will be taken back during audit which means the pharmacy is basically handing the medication out for free.
Since these vaginal creams only come in one package size, instructions rarely support the days’ supply to be 30. This makes your claims easy targets if you are consistently defaulting the days’ supply. Software default fields, plan limits, or data entry errors should all be reviewed to ensure you have safeguards in place to prevent losing these claims.
|Product||Package Size||Applicator Measurements|
|Estrace® (estradiol) 0.01% vaginal cream||42.5 gram||1 to 4 grams|
|Premarin® (conjugated estrogens) vaginal cream||30 gram||0.5 to 2 grams|