Small Differences Between Prescription Directions and Patient Label Can Lead to BIG Recoupments

PAAS National^® recommends attention to detail when it comes to typing directions for patient labels. Many PBMs require the patient label directions match the prescription directions exactly, or a pharmacy may face recoupment for a “misfilled” prescription.

Errors on the patient label can range from simple typos to dosing errors. Even seemingly innocuous additions to the patient label (e.g., a diagnosis code or time of administration) can lead to potential audit discrepancies when added without prescriber approval (or documentation). If the prescription directions are clarified with the prescriber’s office, make sure to add a clinical note and update the patient label. See our November 2020 article Are Your Pancreatic Enzyme Prescriptions Audit Ready? for a common issue between the prescription directions and patient label.

Another problematic patient label issue PAAS frequently sees is regarding units. Consider Victoza^®, which typically has directions in mg, but has often been mistyped as mL. See our January 2021 article Victoza – One Letter Can Cost You! for more detail.

PAAS Tips:

• Label directions should be typed exactly as they appear on the prescription and mathematically calculable for days’ supply
  • PBMs look to recoup on a prescription/label mismatch when it could cause a clinical error or if it appears that a clinical annotation was added after the prescription was dispensed
  • Adding the route of administration is typically not an issue unless the route added is incorrect (see our September 2019 article Route of Administration is Important)
• If clarifying directions with the prescriber, the updated directions need to be included on the patient label
• Examples of instructions that should be clarified:
  • Sliding Scale Insulin without a max daily dose, pancreatic enzymes taken with meals and snacks, and instructions to be taken “As Needed” should have a maximum daily dose
  • “Use as Directed” – per package? Off-label? See PAAS Newsline article February 2022 Use Care with Unit of Use Packages and “Use as Directed” for more information
  • Topical products should ideally contain a mathematically calculable amount to be applied per application or maximum per day. See our Topical Creams and Ointments days’ supply chart for more details
• Diagnoses should only be included if written by the prescriber