Best Practices When Filling & Billing Afrezza®
Afrezza®, a rapid-acting insulin human inhalation powder for adults with either type 1 or type 2 diabetes mellitus, can cause confusion for prescribers, pharmacies, and patients alike.
Entries by Meredith Thiede, PharmD
Best Practices for DAW Billing in Pharmacies
In what should be a fairly straightforward process, proper DAW billing practices can be convoluted. Despite NCPDP guidance to standardize adjudication practices, PBMs do not always adopted these standards, leaving the pharmacy in a gray area of what proper DAW billing should look like.
Don’t Cut Corners: Notations on Prescriptions
Not only are new medications frequently released to market, but also new strengths and formulations of existing medications.
Elixir Audit Notice Delivery Methods
What is worse than receiving an audit notice? Receiving audit results which state “NRS – No Response to Audit Request” when the pharmacy never received the audit notice.
Zepbound (tirzepatide) Means Decreased Audit Risk…Right?
, PAAS National® would like to take this opportunity to update our members on what PBM trends we have seen thus far, draw attention to the guidelines laid out by PBMs and regulations in which we can rely on, and give our thoughts on the current audit situation in the hopes of allowing you to make the most informed business decision.
Auditors Become Increasingly Stringent on Quantity and Unit of Measure Appeals
You may recall the article “Quantity Changes Cause Audit Appeal Trouble ” from the May 2023 Newsline. The article discusses how PAAS National® saw an increase in the number of discrepancies for “unauthorized” refills.
Albuterol HFA Inhaler Substitution Refresh
There have been many new albuterol HFA NDCs released since the June 2020 article, First AB-Rated Generic for Proventil® HFA Approved, and since albuterol inhaler substitutions require an extra level of consideration due to not all NDCs being equivalent, a refreshed chart was in order.
You’ve Got Mail! Post-COVID-19 Mailing & Delivery Considerations
After three years of a Public Health Emergency (PHE) due to COVID-19, the Department of Health and Human Services (HHS) allowed the PHE to expire May 11, 2023. With the end of the PHE came the end of most PBM concessions, including those made in relation to mailing and delivery of medications.
Fair Access for All: The Proposed Rule’s Potential to Strengthen Anti-Discrimination in Pharmacies
The Biden-Harris Administration is continuing to bolster the importance of equal access to health care and human services for individuals with disabilities through a new proposed rule.
An Easy Procedural Change That Will Prevent Recoupments
As previously reported in an April 2023 Newsline article, Prepare Yourselves! Onsite Audits Are Coming in Strong, PAAS National® saw a 300% increase in onsite audits in just the 3rd Quarter of 2022, and we have continued to see the number of audits, as well as the information requested in these audits, increase.
