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

Sara Hathaway, PharmD