Humana Provides Update on GLP-1 Prescriptions
PAAS National® has recently become aware of an update Humana published regarding new point-of-sale edits for specific medications. Included in this list are GLP-1 agonists.
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Effective June 2023, Humana commercial, Medicare and Medicaid plans will now require diagnosis codes at point of sale in hopes of eliminating the “clinical misuse” of certain medications. Pharmacies can find this information posted on the Humana website under the Pharmacy Resources tab.
Be aware that a diagnosis field is likely not reviewed by the PBM unless the plan requires it on claim submission. Entering in a diagnosis code and receiving a paid claim does not affirm plan benefit design nor guarantee coverage.
Analyst at PAAS National®
As a Certified Pharmacy Technician at PAAS, I am here to assist and provide you with pre- and post-audit advice. I can also provide product and billing information.
I attended Madison College in nearby Madison, WI (PAAS headquarters are in the Madison suburb of Stoughton). Prior to coming to work at PAAS, I worked as a Certified Pharmacy Technician in a retail setting for 25+ years. Pharmacy has been my life’s work.
Helping our members have a successful audit experience is very rewarding. Celebrating with them, when PAAS often helps generate positive post-audit results, is the best part of my work.
I attended Madison College in nearby Madison, WI (PAAS headquarters are in the Madison suburb of Stoughton). Prior to coming to work at PAAS, I worked as a Certified Pharmacy Technician in a retail setting for 25+ years. Pharmacy has been my life’s work.
Helping our members have a successful audit experience is very rewarding. Celebrating with them, when PAAS often helps generate positive post-audit results, is the best part of my work.
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