PBM Communications to Network Pharmacies Can Help Prevent an Audit!
PAAS National® knows community pharmacies are busier than ever, making it difficult to keep up with all the PBM communications. Just as PAAS provides monthly Newsline articles to keep our members up-to-date on current PBM trends and audit tactics, the PBMs also have resources to communicate with network pharmacies. Below are PAAS tips outlining which PBMs send out communications, how often they are sent and a link to their website or login page. These resources often give insight on audit targets and network compliance issues.
PAAS Tips:
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!
- Caremark
- Sends out memos when applicable and relevant
- These memos are not publicly available, pharmacy must log into the portal for access
- https://rxservices.cvscaremark.com/
- Elixir
- Bi-annual “Pharmacy Audit Whisperer” bulletin to network pharmacies
- The most current audit whisperer from April 20, 2023, has a Medicare Part D focus and advice on how to maintain pharmacy compliance by ensuring claims billed to Part D are prescribed for a medically accepted indication and not being used off label
- https://www.elixirsolutions.com/providers
- Express Scripts
- Sends out communication letters when applicable and relevant
- These letters are not publicly available, pharmacy must log into the portal for access
- https://www.esiprovider.com/gen/express-scripts/index.cfm?cmd=1
- Humana
- Sends important news bulletins
- These bulletins are not publicly available so pharmacy would need to log into the portal for access
- https://account.humana.com/
- MedImpact
- Send messages about billing guidance and regulatory/program notices
- These letters are not publicly available, pharmacy must log into the portal for access
- https://pharmacy.medimpact.com/
- Navitus
- Spring and Winter Pharmacy Newsletter
- Monthly network bulletins
- These are not publicly available; pharmacy would need to log into the portal for access
- https://pharmacies.navitus.com/
- OptumRx
- Monthly RxHighlights discussing recaps of new brand and generic drug approvals, revised drug indications or label updates, safety, recalls, withdrawals, shortages, new or revised treatment guidelines or recommendations
- https://professionals.optumrx.com/publications/rx-highlights.html
- Prime Therapeutics
- Bi-Annual (June and December) pharmacy newsletters that provide information and updates about Prime services
- The June 2023 letter discusses FWA updates for diabetic medications used for weight loss
- https://www.primetherapeutics.com/resources/prime-perspective-newsletters/
PBM’s expect their network pharmacies to be familiar with the topics and information they provide and will hold you accountable for network compliance. PAAS will help keep you up to date on relevant communications, but should you receive any direct PBM communications (via email or fax), be sure to forward them to PAAS for review.
I have a Bachelor of Science degree from the University of Wisconsin-River Falls and have been a Certified Pharmacy Technician since 2001. Prior to joining the PAAS team, I was a floating technician, 3rd party district chargeback specialist, and district pharmacy training coordinator. Formerly, I was also an instructor for pharmacy technician certification classes.
PAAS’ personal, one-on-one connection will help your pharmacy become more successful in dealing with tiresome PBM audits. It is a pleasure knowing that my colleagues and I can help member pharmacies.
- New Tool on PAAS Portal – Exceeding Days’ Supply Plan Limits for Unbreakable Packages - December 1, 2024
- Understanding Biologic Substitutions – New Tool Available! - November 12, 2024
- FDA Proposed Guidance for Biosimilar Updates - October 23, 2024
