Pharmacies are familiar with submitting copies of prescriptions, signature logs and proof of copay collection upon an audit request, but do you have documented proof of the offer to counsel? While the patient can accept or refuse counseling, it must be documented for Medicaid patients. PAAS National®®® analysts often see pharmacies with these requests during Medicaid […]
The July 2024 PAAS National®® Newsline article, What’s New with Prescription Validation Requests in 2024? compared the top five drugs targeted in the first six months of 2024. The chart below shows the top drugs picked for claim reviews in the second half of 2024, and a recap of the first half of 2024.
Prescriber statements have become one of the most valuable tools a pharmacy can use when needing to appeal claims found to be discrepant for a variety of reasons. They commonly take the form of a letter written by the prescriber to the PBM confirming, clarifying, or validating a prescription filled by your pharmacy. While every […]
PAAS National®® wants to emphasize the importance of submitting the correct days’ supply on claims. We see many audit results that could have been avoided had the pharmacy addressed the initial rejection and not bypassed the plan limit. A prevention strategy is important because these discrepancies are often difficult to appeal successfully. Pharmacy employees should […]
ARS Pharmaceuticals Operations has recently introduced neffy® 2 mg, the first and only FDA-approved needle-free way to administer epinephrine. neffy® is a nasal spray used for emergency treatment of severe allergic reactions in adult and pediatric patients who weigh at least 66 pounds (30 kg). Per DailyMed, “the recommended dosage of neffy® is one spray […]
PAAS National® is continuously updating and creating new tools to help our members address common audit recoupment issues.
Our PAAS National® analyst team developed a new tool to assist pharmacies with biologic substitutions. Understanding when to substitute and what to substitute with can be complicated.
Over the last 10 years, biologics have transformed the treatment of many illnesses like chronic bowel disease, kidney disease, arthritis and cancer and they are the fastest growing class of medications in the United States.
OptumRx® has employed a new strategy to recoup more money on your pharmacy claims. Often upon an audit, if a pharmacy submitted an incorrect days’ supply, the PBM will re-adjudicate the claim with the correct days’ supply.
The Department of Justice recently announced the sentencing for a California (CA) pharmacy owner and their co-conspirator for submitting fraudulent claims to Medicare and CA Medicaid for prescription drugs that were never dispensed to beneficiaries.
