Understanding Biologic Substitutions – New Tool Available!
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.
Entries by Jennifer Ottman, CPhT
FDA Proposed Guidance for Biosimilar Updates
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.
Avoid OptumRx® Double Chargeback Pitfalls – Review Your Days’ Supply
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.
Unveiling a Health Care Fraud and Illegal Black-Market Conspiracy
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.
Flu Shot Season – Are You Prepared?
Flu shot season is just around the corner and PAAS National® wants to make sure you reduce your risk of audit recoupments. As busy as the flu season can be, it is important to follow the best practices and PAAS tips below to ensure you have all documentation in place.
PBM Audits on Ozempic®: 5 Common Discrepancies Revealed
Popularity for GLP-1 medications, like Ozempic®, continues to grow and, consequently, PAAS National® encounters these drugs on PBM audits frequently.
Liraglutide Injection Marks Debut as First Authorized Generic GLP-1 Product
In late June, Teva Pharmaceuticals launched the first “generic” GLP-1 (Glucagon-Like-Peptide-1) receptor agonist in the United States, known as Liraglutide injection (6 mg/mL).
What’s New with Prescription Validation Requests in 2024?
In the PAAS National® January 2024 Newsline article PBM Validation Requests Rose 123% in 2023 – What You Need to Know, we discussed the PBM trends we saw in 2023. Below is a list of drugs reviewed and analyst comments that have been compiled through the first six months of 2024 for comparison.
The Different Cyclosporine Eye Drops That Could Cause Audit Trouble
Cyclosporine eye drops are used to increase tear production in individuals with certain eye conditions and dry eye disease.
OptumRx Continues to Cause Headaches!
PBMs monitor, and flag, migraine medications due to excessive cost, quantities submitted, days’ supply (and/or frequency of refills) and vague instructions.
