2024 Self-Audit Series #7: Migraine Medications
In recent years, there has been a notable increase in the number of medications prescribed for migraine prevention and treatment. This increase leads to additional audit risks. Many of these medications are not only high dollar claims but are frequently targeted by PBMs due to a lack of calculable instructions or billing errors. Be sure your pharmacy is aware of these potential issues and educate staff on how to avoid audit discrepancies.
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Migraine medications that are taken on an “as needed” basis carry the highest risk of being found discrepant on audit results. Without knowing the number of headaches per week or month the patient can treat, or the specific number of doses the prescriber has authorized them to use, it is not possible to bill an accurate days’ supply. This information should be verified with the prescriber, documented on the prescription with a clinical notation, and included on the patient’s label prior to dispensing. Pharmacies can confirm recommended dosing per manufacturer under Section 2 of each medication’s package insert, or visit DailyMed for this information.
Some migraine medications are taken on a regular basis for migraine prevention. These range from tablet form to injectables. With specific instructions of frequency and amount per administration, these prescriptions should have enough information for pharmacies to bill the appropriate days’ supply but review our PAAS Tips articles for common pitfalls.
PAAS Tips:
- Visit the Member Portal where you can find several past Newsline articles with guidance on billing migraine medications
- August 2024, Do The Math and Avoid the Recoupment
- June 2024, OptumRx Continues to Cause Headaches!
- April 2024, Numerous Sumatriptan Formulations Cause Headaches for Pharmacies, & Potential Recoupments
- August 2023, Migraine Medications Continue to Cause Headaches
- Self-Audit prescriptions under the migraine category on a frequent basis to ensure accuracy in directions and billing
I attended Madison College in nearby Madison, WI (PAAS headquarters are in the Madison suburb of Stoughton). Prior to coming to work at PAAS, I worked as a Certified Pharmacy Technician in a retail setting for 25+ years. Pharmacy has been my life’s work.
Helping our members have a successful audit experience is very rewarding. Celebrating with them, when PAAS often helps generate positive post-audit results, is the best part of my work.
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