2024 Self-Audit Series #9: Eye Drop Days’ Supply
Billing the accurate days’ supply for eye drops can be challenging. Despite what is drilled into pharmacists during schooling, there is no industry standard for drops/mL, and PBMs often use their own specific conversion factors. This variability adds complexity to accurately determining the appropriate days’ supply.” The PAAS National® Eye Drop Guidance chart has been created for our members to have the most up to date information from the major PBM provider manuals to assist them with this process.
Pharmacies must also take into consideration several eye drops that do not fall under the typical drops/mL conversion due to beyond use dating, single use vials, or atypical drop size. Recognizing these extra billing considerations is imperative to avoid potential audit issues.
Please refer to the following Newsline articles for information on some of these specific eye drops:
- The Different Cyclosporine Eye Drops That Could Cause Audit Trouble (June 2024)
- Miebo™ Eye Drops – What is the Days’ Supply? (March 2024)
- Be on the Lookout for Eye Drops Requiring Extra Billing Consideration (March 2024)
- Days’ Supply Considerations for Eye Medications (January 2024)
PAAS Tips:
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- Verify the prescription has mathematical instructions for use and clarify any ambiguous directions
- Download the PAAS National® Rx Days’ Supply Calculator app
- Do not assume the days’ supply indicated on electronic prescriptions is correct, always calculate days’ supply according to instructions for use
- Best practice is for quantity prescribed to include a unit of measure; however, if written for a quantity of “1 bottle”, it should be interpreted as the smallest package size
- When billing a PBM not listed on the Eye Drop Guidance, PAAS recommends using 15 drops/mL for suspensions or emulsions, and 20 drops/mL for solutions, unless otherwise specified by the manufacturer
- Billing eye drops for LTC patients carries the same audit risk, refer to the following June 2022 Newsline article, Beyond-Use Date vs. Nursing Home Storage Policy – Avoid this Recoupment Trap
- Prescriptions with a treatment duration (e.g., “use for 10 days”) that is less than calculated days’ supply, should still be submitted per calculation
PAAS Audit Assistance members can search the Newsline archive for keyword “2024 self-audit” to read previous articles in this series. If you have any questions on accessing the Member Portal, or need help adding employees so they have access, please contact us.
I attended Madison College in nearby Madison, WI (PAAS headquarters are in the Madison suburb of Stoughton). Prior to coming to work at PAAS, I worked as a Certified Pharmacy Technician in a retail setting for 25+ years. Pharmacy has been my life’s work.
Helping our members have a successful audit experience is very rewarding. Celebrating with them, when PAAS often helps generate positive post-audit results, is the best part of my work.
- 2024 Self-Audit Series #9: Eye Drop Days’ Supply - November 20, 2024
- Self-Audit Series #8: Compound Prescriptions - October 21, 2024
- Medicare and Vaccine Billing: What You Need to Know - October 5, 2024
