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.
Entries by Jennifer Ottman, CPhT
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.
Are You Prepared for a Spravato® Audit?
PAAS National® has seen audits with full claim recoupments being requested as a result of missing dosage and frequency instructions, as well as incomplete dispensing records. To minimize the risk of a Spravato® claim being recouped during an audit, consider the following PAAS tips …
Documentation is Essential for Prescription Quantity Changes
Anytime a pharmacy dispenses a quantity different than what the prescriber ordered, there should be a reason documented on the prescription for the decreased or increased quantity.
NDC Numbers: Not a Guarantee of FDA Approval
A common misconception that pharmacies have is that if a product has an NDC (National Drug Code) number that means it is approved by the FDA – unfortunately, this is not the case.
Bowel Prep Products – What Quantity and Days’ Supply to Bill?
The most common PBM audit issue PAAS sees with bowel prep products is billing an incorrect days’ supply.
Miebo™ Eye Drops – What is the Days’ Supply?
Miebo™ is the first and only prescription eye drop used to treat dry eye syndrome by directly targeting tear evaporation. PAAS National® has fielded several calls regarding Miebo™ asking how to calculate the days’ supply.
