What’s New with Prescription Validation Requests in 2024?

In the PAAS National® January 2024 Newsline article PBM Validation Requests Rose 123% in 2023 – What You Need to Know, we discussed the PBM trends we saw in 2023. Below is a list of drugs reviewed and analyst comments that have been compiled through the first six months of 2024 for comparison.

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Top 5 drugs reviewed in 2023 compared to first half of 2024:

January-June 2024 January-December 2023
Ozempic® Lantus®
Nurtec® Humalog®
Mounjaro® Creon®
Creon® Levemir®
Ubrelvy® Invega®


While Creon® is still one of the top PBM targets, you can see that during the first half of 2024, the PBMs have shifted their focus from monitoring insulin claims to GLP-1s and migraine medications, demonstrating how PBM audit trends change over time. Be assured that the PBMs will continue to send claim reviews for insulin as well. While they may not show in the top 5 drugs of 2024 so far, Tresiba®, Humalog®, Levemir®, insulin lispro and Toujeo® were all right behind Ubrelvy® in the number of claim reviews the PBMs have issued to date in 2024.

The top 5 comments noted by an analyst after claim review mimic the same 5 from 2023:

  1. Document the reason for the cut quantity – auditor will want to know why the pharmacy dispensed less that what was prescribed
  2. Black out acquisition cost and/or profit margin values on the backtag
  3. A clinical notation is needed and requires 4 elements: Date, who you spoke with and their title, what they confirmed, and the pharmacy employee initials
  4. No backtag/sticker attached, typically requested by the PBM and helpful for PAAS to review the billing elements
  5. Verify the quantity prescribed and make a clinical notation on the hard copy – Unit of Measure (UOM) is not specified or does not make sense for the medication ordered

PAAS Tips:

Jennifer Ottman, CPhT