Forteo® Package Size Update – Are You Billing the Correct Cost?
Forteo® (teriparatide injection) is a parathyroid hormone analog (PTH 1-34) used in the treatment of osteoporosis, specifically for postmenopausal women at high risk for fractures, men with primary or hypogonadal osteoporosis, and individuals with osteoporosis associated with sustained glucocorticoid therapy. It is designed to increase bone mass and reduce fracture risk in patients who have failed or are intolerant to other osteoporosis therapies. Administered via a prefilled pen, each pen delivers 28 daily doses of 20 mcg.
In a recent update on August 23, 2024…
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!
the FDA revised the product labeling to reflect a change in the pen’s composition from a 600 mcg/2.4 mL pen to a 560 mcg/2.24 mL pen. Despite this adjustment, the pen continues to deliver 28 subcutaneous doses, and the NCPDP billing quantity and unit still reflect the previous 2.4 mL measure.
PAAS National® has been in contact with NCPDP about this discrepancy, and has learned the following:
- Medi-Span® and the other compendia were NOT notified by Lilly of this change.
- Lilly did not change the package code segment of the NDC that indicates the package size and type.
- The NCPDP WG2 Task Group will be discussing this issue and deciding what action to take.
What does this mean for your pharmacy? You should verify how your software currently bills Forteo®. Make sure that when submitting a claim, the metric quantity aligns with what is displayed in your software system’s compendia and that the correct cost for one pen is included in your transmission. As of the time of publication of this article, the approximate wholesale accusation cost (WAC) for one pen is $4,200.
PAAS Tips:
- Wholesaler ordering websites may not list products in the same NCPDP billing unit or package size
- A similar product that has unusual billing is AndroGel® Pump (and generics) that list 88 g on the outer packaging but only delivers 75 g – NCPDP defines billing as 75 g
- Questions about billing quantity or unit of measure? Send us a question through the Ask a PAAS Expert on the Member Portal
I have a Bachelor of Arts in Communications from the University of Wisconsin – Madison. Prior to joining PAAS in 2017, I worked for Walgreens for 19 years.
As an Analyst at PAAS, I really enjoy being able to help independent pharmacies succeed. I have always been a fan of the underdog and am excited to be able to give you the tools you need to take on the giants of the PBM industry.
- Forteo® Package Size Update – Are You Billing the Correct Cost? - December 12, 2024
- Why the Unit of Measure Matters in Audits: A Small Factor with Big Consequences - December 10, 2024
- Representative NDC on Electronic Prescriptions Do Not Infer Specificity - November 24, 2024
