Are You Billing Divigel® Correctly?

Billing packaged products according to their proper size and unit of measure is crucial for pharmacies, as this common pitfall could result in hefty recoupments from PBMs.

When it comes to billing insurance, a medication like Divigel^® (estradiol) transdermal gel packets can be confusing for pharmacies, as different strengths use different billing units. Some are measured in “each”, while others use “grams”. So, why the discrepancy?

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According to the NCPDP Billing Unit Standard Fact Sheet, “Unit-of-use packages with a quantity less than one milliliter or gram should be billed as ‘one each’. For example, ointment in packets of less than 1 gram or eye drops in dropperettes that are less than 1 mL. This rule does not apply to injectable products.” This rule does apply to Divigel^®.

The 0.25 mg, 0.5 mg and 0.75 mg strengths fall under the rule and should be billed using the unit of measure each. A full box of 30 packets is billed as 30 each.
For the 1 mg and 1.25 mg strengths, each packet contains 1 gram or more, so these are billed in grams. To determine the correct package size, multiply the number of grams per packet by the number of packets in a box.

Refer to the table below for a breakdown of the appropriate package sizes and billing units for each strength of Divigel^®.

Strength	NDC	Package Size	Unit of Measure
Divigel^® 0.25 mg/0.25 gm	68025-0065-30	30	Each
Divigel^® 0.5 mg/0.5 gm	68025-0066-30	30	Each
Divigel^® 0.75 mg/0.75 gm	68025-0083-30	30	Each
Divigel^® 1 mg/gm	68025-0067-30	30	Grams
Divigel^® 1.25 mg/1.25 gm	68025-0086-30	37.5	Grams

PAAS Tips:

Ensure staff is aware of which strengths are billed as “EA” vs “gm”
Check that your software has the appropriate quantity for each strength
When in doubt, ask a PAAS analyst!
For more information regarding unit of measure, please see December 2024 Newsline article, Why the Unit of Measure Matters in Audits: A Small Factor with Big Consequences

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Heaven Bennett, CPhT

Analyst at PAAS National^®

Fresh out of high school, I had no idea what I wanted to do for my career. I took a job at Walgreens in the photo department in 2015. About a year into working in the photo department I was asked to help the pharmacy, and I immediately fell in love with how fulfilling being a pharmacy technician felt. I moved fully into the pharmacy, got my national certification, and worked my way up to becoming Senior Technician! In 2020, I accepted a job offer with a Kroger pharmacy location and worked there for two years. I attended vaccine clinics and got to see sides of the pharmacy I had never seen before. I was then offered a change in direction in 2022. I was lucky enough to work for a remote pharmacy company that helped independent pharmacies run a med sync service, as well as sending out safety alerts to providers in hopes of preventing accidental opioid overdosing and interactions. The connections I made at my previous jobs have brought me here, to PAAS! I am over the moon with excitement and look forward to helping your pharmacy!

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