Audit Target: Linzess® Prescriptions
PAAS National® analysts have noticed an increase in audits targeting Linzess®.
Entries by Dana Westberg, CPhT
Auditors’ Latest Trick for Flagging “Misfilled” Prescriptions
PAAS National® analysts are noticing more prescriptions being flagged for recoupment based on “incorrect” instructions for use on the patient label. Pharmacies and PBM auditors have very different perspectives on what a “misfilled” prescription is.
Utilizing the PAAS Audit Activity Tracker
While seemingly mundane, the PAAS National® Audit Activity Tracker can serve a very important purpose. While pharmacy personnel may use this tool to stay organized with various audits coming their way, this tool can also be used to defend the pharmacy should an audit go awry.
NADAC Survey: What is It and Do I Need to Respond?
Pharmacies that receive a National Average Drug Acquisition Cost (NADAC) Survey frequently contact PAAS National® for information and guidance.
When Are Final Audit Results Not Final?
Receiving audit results with discrepancies and financial recoupments can be very discouraging. PAAS National® analysts are here to assist you through the appeal process. Audit results do not always provide all appeal options, and you don’t want to miss out on another chance if your initial appeal is denied.
Caution with Script Care Audits
PAAS National® has seen a rise in desk audits from Script Care.
Auditors Crack Down on Pharmacies That Bypass Plan Limits
PAAS National® analysts want to warn pharmacies about an uptick in PBMs flagging prescriptions for bypassing plan limit rejects.
Remember to Maintain and Provide Complete Clinical Notes!
Pharmacies must be very diligent with electronic documentation when electronically storing their prescriptions.
Dispense in Original Container – Know the Audit Risks
PAAS National® analysts want to remind pharmacies of the audit risks when medications are dispensed outside manufacturer storage/dispensing requirements.
Humana Provides Update on GLP-1 Prescriptions
PAAS National® has recently become aware of an update Humana published regarding new point-of-sale edits for specific medications.
