Are You Missing Audit Communications?
PAAS National® analysts have recently seen many PBMs and audit contractors send communications, including audit letters, to network pharmacies via email instead of facsimile or postal mail.
Entries by Eric Hartkopf, PharmD
Billing Guidance: When to Use DAW 0 vs DAW 9
PAAS National® analysts frequently see PBM audit results where auditors have flagged claims with ‘incorrect DAW code submitted’ – while these are often educational discrepancies, it is important to understand the implications of incorrect DAW code submission and develop a consistent process for pharmacy staff to follow.
LifeScan Extortion – Diabetic Test Strip “Authorized Distributors”
For the second time in the last three years, numerous pharmacies have received, what PAAS National® would consider extortionary, letters from LifeScan.
Best Practices for Dispensing GLP-1 Medications and Reducing Recoupment Risk
Pharmacies continue to see a large number of prescriptions for GLP-1 medications like Ozempic and Mounjaro and have concerns about the risk of PBM audits and recoupments.
Caremark Memo: Novolog® and Novolin® ReliOn®
PAAS National® frequently gets questions about whether pharmacies may substitute various medications and if such substitutions require the approval of the prescriber.
Biologic Drug Substitution Best Practices (Update)
PAAS National® frequently gets questions about whether pharmacies may substitute various medications and if such substitutions require the approval of the prescriber.
Caremark Resumes Signature Log Requirements Effective May 12, 2023
Caremark issued a Pharmacy Update memo on March 8, 2023, stating that they would resume signature log requirements for audits effective May 12, 2023.
Express Scripts Provider Manual – 2023 Updates
All PBMs update their Provider Manuals at regular intervals and Express Scripts (ESI) is no exception.
Medicare Caps Copay for Insulin at $35 per Month
As most of you (and your Medicare patients) have undoubtedly noticed, Medicare has applied a $35 per month cap on copays for insulin prescriptions ($105 for a 3-month supply) for years 2023-2025.
Ozempic and Mounjaro Prescriptions – Between a Rock and a Hard Place
Many pharmacies continue to receive new prescriptions from patients eager to start on therapy for Ozempic and Mounjaro.
