PBMs Require “Cut Quantity” Documentation

Whenever a pharmacy dispenses a quantity less than what the prescriber ordered, there should be a reason documented for the “cut quantity”. PBMs want to know why the pharmacy is dispensing less than what was prescribed. There are many reasons why this could happen, but the three most common are:

1. Insurance Limits the Quantity – if the prescription is written for a 90-day supply but the plan only covers 30 days, the pharmacy can document “ILQ = 30 days” on the hard copy
2. Sometimes the patient requests a lesser amount than what was prescribed – pharmacy can document “patient requested one month” or whatever quantity or number of days is requested
3. A pharmacy may be trying to sync a medication with the patient’s other medications – “med sync” should be documented in this case

PAAS has seen a few PBMs try to recoup on cut quantities if the pharmacy did not have the reason documented. PAAS Audit Assistance members can view chart of audit discrepancy codes on eNewsline.