Could You Be Giving Vaginal Creams Away for Free?

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

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  • PBMs look for calculable instructions (e.g., grams per application or max grams per week/month)
  • Instructions for “pea-sized amount” or “X number of inches” are not sufficient for audit purposes
    • For a pea-sized amount, work with prescribers to clarify if 0.25 grams would be appropriate (half of a finger-tip unit)
  • Clarify any instructions that do not provide enough information to accurately calculate days’ supply
  • See our June 2021 Newsline article, Self-Audit Series #5: Topical Prescriptions
  • Always submit an accurate days’ supply first, as many plans now have overrides for exceeding plan limits
  • Refer to our Can You Bill It As 30 Days? in our Tools & Aids section if plan limits are exceeded
  • Self-audit your vaginal creams for accurate days’ supply and appropriate instructions
  • Vaginal creams are not recommended to be part of a patient’s med sync program – refill upon request only
Dana Westberg, CPhT