PBM Enforcement of Return to Stock Policies

PAAS National® wrote an article in our April 2020 Newsline regarding PBMs Enforcing Return to Stock Policies. A PBM will recoup a claim in full if a medication is picked up after their required return to stock timeframes listed in the respective provider manuals. The provider manual may reference these as “unclaimed prescriptions.” Pharmacies should have a policy and procedure in place to only allow medications to remain in the will call bins for the shortest outlined time – 10 days. If your pharmacy has PAAS National®’s Fraud, Waste & Abuse and HIPAA Compliance (FWAC) program, a return to stock policy is available to you, including a log to help you document and complete this task (see section 4.1.1 Unclaimed Prescriptions and Appendix B – Unclaimed Prescription Reversal Log).

Major PBM Return to Stock Timeframes:

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Calendar Business
10 days 13 days 14 days 10 days 15 days
MeridianRx
Serve You Rx
TRICARE
Express
Scripts
Aetna
Caremark
Elixir
MagellanRx
MedImpact
Navitus
OptumRx
Prime Therapeutics
Southern
Scripts
Humana

PAAS Tips:

  • Pharmacies should not leave prescriptions in the will call bins for more than 10 days to comply with the shortest return to stock timeline of 10 days per MeridianRx, Serve You Rx and TRICARE.
  • These return to stock timelines also apply to completions (aka “partial fills”) left in the will call bins
  • PBM return to stock policies are still required to be met during the COVID-19 pandemic
  • LTC prescriptions are not exempt from these return to stock policies
  • If you are a FWAC member and change your procedure for returning medications to stock, be sure to have your admin or compliance officer update section 4.1.1 of your Policy and Procedure manual
Jennifer Ottman, CPhT
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