PBM Enforcement of Return to Stock Policies
PAAS National® wrote an article in our April 2020 Newsline regarding PBMs Enforcing Return to Stock Policies. A PBM will recoup a claim in full if a medication is picked up after their required return to stock timeframes listed in the respective provider manuals. The provider manual may reference these as “unclaimed prescriptions.” Pharmacies should have a policy and procedure in place to only allow medications to remain in the will call bins for the shortest outlined time – 10 days. If your pharmacy has PAAS National®’s Fraud, Waste & Abuse and HIPAA Compliance (FWAC) program, a return to stock policy is available to you, including a log to help you document and complete this task (see section 4.1.1 Unclaimed Prescriptions and Appendix B – Unclaimed Prescription Reversal Log).
Major PBM Return to Stock Timeframes:
Become an audit assistance member today to continue reading this article. As a member, you’ll have access to hundreds of articles and receive our monthly proactive newsletter!
| Calendar | Business | |||
|---|---|---|---|---|
| 10 days | 13 days | 14 days | 10 days | 15 days |
| MeridianRx Serve You Rx TRICARE |
Express Scripts |
Aetna Caremark Elixir MagellanRx MedImpact Navitus OptumRx Prime Therapeutics |
Southern Scripts |
Humana |
PAAS Tips:
- Pharmacies should not leave prescriptions in the will call bins for more than 10 days to comply with the shortest return to stock timeline of 10 days per MeridianRx, Serve You Rx and TRICARE.
- These return to stock timelines also apply to completions (aka “partial fills”) left in the will call bins
- PBM return to stock policies are still required to be met during the COVID-19 pandemic
- LTC prescriptions are not exempt from these return to stock policies
- If you are a FWAC member and change your procedure for returning medications to stock, be sure to have your admin or compliance officer update section 4.1.1 of your Policy and Procedure manual
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.
- FDA Proposed Guidance for Biosimilar Updates - October 23, 2024
- Avoid OptumRx® Double Chargeback Pitfalls – Review Your Days’ Supply - October 1, 2024
- Unveiling a Health Care Fraud and Illegal Black-Market Conspiracy - September 17, 2024
