Numerous Sumatriptan Formulations Cause Headaches for Pharmacies, & Potential Recoupments
Sumatriptan is FDA approved for the acute treatment of migraine headaches, with or without aura. It is available in numerous formulations and strengths which can cause confusion during the filling and billing process. To decrease your risk of audit, and recoupment, be sure staff are aware of the nuances of sumatriptan and follow the guidance below.
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| Formulation | Strength | Available package size | NCPDP Billing Units |
| Auto-Injector | 4 mg/0.5 mL
6 mg/0.5 mL |
2 syringes/box | 1 mL |
| Nasal solution | 5 mg/actuation
20 mg/actuation |
6 nasal inhalers/box | 6 EA |
| Oral tablets | 25 mg
50 mg 100 mg |
Unit of use boxes with 9 or 27 tablets or bottles with various quantities | # EA |
| Pen kit with cartridges | 4 mg/0.5 mL
6 mg/0.5 mL |
2 cartridges/box | 1 mL |
| Refill cartridges for use with pen kit | 4 mg/0.5 mL
6 mg/0.5 mL |
2 cartridges/box | 1 mL |
| Single use vial | 6 mg/0.5 mL | Carton with 1 vial, 5 vials, or 25 vials | 0.5 mL, 2.5 mL, 12.5 mL (respectively) |
| Lesser Known Formulations | |||
| Zembrace® SymTouch® Auto-Injector | 3 mg/0.5 mL | 4 pens/carton | 2 mL |
| Onzetra® Xsail® Nasal powder | 11 mg/nosepiece (using two nosepieces [22 mg] per administration) | 8 dose kit (8 pouches containing 2 nosepieces per pouch) | 16 EA |
PAAS Tips:
- Verify all sumatriptan prescriptions contain the dosage, formulation, quantity, and directions
- Vague instructions for use such as “Use as Directed” and “as needed” should always be clarified. Obtaining the estimated number of headaches per week or per month from the prescriber (particularly if dispensing >1 package) allows the pharmacy, and auditor, to estimate an accurate days’ supply Remember to update the hardcopy with a clinical note and update the patient label to include the additional instructions
- A complete clinical note should include:
- Date (and preferably time)
- Name and title of individual providing information
- Specific information provided
- Pharmacy staff initials
Analyst at PAAS National®
After graduating from UW-Madison's School of Pharmacy with my PharmD, I spent my first eight years at an independent pharmacy dividing my time between both retail and long-term care. I fell in love with the independent pharmacy world and joined the PAAS team to help independents not only survive, but thrive.
I enjoy assisting pharmacy staff both pre- and post-audit and enjoy providing them with knowledge and tools to decrease audit risk going forward. I write articles for Third-Party Newsline each month and answer member questions daily. I look forward to building professional relationships with each of our members and assisting you with your next audit.
I enjoy assisting pharmacy staff both pre- and post-audit and enjoy providing them with knowledge and tools to decrease audit risk going forward. I write articles for Third-Party Newsline each month and answer member questions daily. I look forward to building professional relationships with each of our members and assisting you with your next audit.
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