What’s New with Prescription Validation Requests in 2025?
In the PAAS National® January 2025 Newsline article, PBM Prescription Validation Requests – What Are They Looking At Now? we discussed the PBM trends we saw in 2024. Below is a list of drugs reviewed and analyst comments that have been compiled through the first six months of 2025 along with a comparison from 2024. While we are not surprised that Ozempic® continues to be the top drug on the prescription validation requests, the others are not surprising either.
| January-June 2025 | July-December 2024 | January-June 2024 |
| Ozempic® | Ozempic® | Ozempic® |
| Invega® | Trelegy Ellipta | Nurtec® |
| Creon® | Eliquis® | Mounjaro® |
| Zepbound® | Epinephrine | Creon® |
| Nurtec® | Creon® | Ubrelvy® |
The top 5 comments noted by an analyst after claim review for the first half of 2025 mirror those from 2024.
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- A clinical notation is needed and requires the following 4 elements:
- Date/time of the call/conversation
- Name and title of who you spoke with
- Specific details about the clarification
- Initials or name of the pharmacy employee making the clarification
- Black out acquisition cost and/or profit margin values on the backtag
- Document the reason for the cut quantity – auditor will want to know why the pharmacy dispensed less than what was prescribed
- 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
- No backtag/sticker provided, typically requested by the PBM and helpful for PAAS to review the billing elements
PAAS Tips:
- Use our Self-audit Mindset tool found under the “Proactive Tips” tab to review your prescriptions prior to sending them to PAAS
- Be sure to include a backtag or screenshot of billing information for a PAAS analyst to review
- Be sure to add all employees to the Member Portal and give them permission to access helpful tools, resources and eNewsline
- Review and utilize our Days’ Supply Charts found on the Member Portal:
- Have a question on a certain topic or medication? Search past Newsline articles to find answers to your questions
- December 2024, Reap the Benefits of the PAAS National® Newsline Archive
Analyst at PAAS National®
I began working at an independent pharmacy in high school and really enjoyed being in the health care field. I provided clinical support to improve patient care and adherence to their medications. I have played a vital role in the pharmacy industry full-time for 23 years.
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.
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.
Latest posts by Jennifer Ottman, CPhT (see all)
- What’s New with Prescription Validation Requests in 2025? - July 27, 2025
- PBMs Are Criticizing Clinical Notes! - July 15, 2025
- Proof of Patient Consent for a Refill Request: What You Need to Know - June 26, 2025
