Optimizing Prescriber Statements: Best Practices and Tips

Prescriber statements should have all the elements of the original prescription, in statement form, and address the reason for the discrepancy:

• Prescriber full name, address and phone number (and DEA for a controlled substance)
• Patient name and date of birth (and address for a controlled substance)
• Written date of prescription
• Medication name, strength, and dosage form
• Quantity and refills prescribed
• Instructions for use
• DAW code if applicable
• Any additional information needed to clarify discrepancy flagged
• Prescriber’s handwritten signature (electronic and stamped signatures are not accepted)
• Date the statement was written/signed

PAAS Tips:

• Each PBM has their own requirements for prescriber statements. Consult with a PAAS analyst to ensure your prescriber statements meet all requirements.
  • Once obtained, PAAS is happy to review, and provide feedback, on your prescriber statement(s)
  • Prescriber statements that do not meet all PBM requirements may be denied on appeal.
• Prescriber statements MUST come from the prescriber’s office. Ensure legitimacy by having the prescriber send you the statement through fax with a cover sheet from their office, especially if it cannot be produced on their letterhead or office prescription pad.
  • Pharmacies should provide all the detailed information needed for the prescriber to be able to create the statement in their own words.
• A prescriber’s office stamp may be used to validate a statement not written on the prescriber’s letterhead, but then the statement should be sent back to the pharmacy by fax with a cover sheet from the prescriber to further prove legitimacy and proof of origin.
• Humana currently uses a prescriber statement template. This template will only be sufficient for Humana appeals and does NOT meet the requirements for other PBMs.
• Remember to add the prescription number to the prescriber statement for auditor reference.