PAAS National®® receives many questions about topical prescriptions, including more complicated products like foam dosage form medications. These products often come in pressurized aluminum cans without a clear way of measuring the product when dispensing. In addition to this issue, prescribers often send prescriptions to the pharmacy with a vague set of instructions. PBMs are […]
We are living in unprecedented times as the Justice Department announced the outcome of their 2025 National Health Care Fraud Takedown, marking one of the largest enforcement actions of its kind. Criminal charges were filed against 324 individuals, from various health care professions, for their alleged participation in a range of fraud schemes. The total […]
We’ve all been in the sticky situation of having a few straggling pills left associated with one NDC that would be ideal to get off the shelf and free up some space. Maybe this NDC used to be the preferred product and now it has changed, or the manufacturer was bought out by another company. […]
OptumRx® continues to maximize chargebacks on pharmacies due to days’ supply errors. It’s important to take the extra time to confirm billing elements are accurate prior to adjudicating – this could save you on the back end of an audit.
Medication synchronization (med sync) programs are common across pharmacies and yield many benefits. Patients can request it to manage medication better and reduce the number of trips needed to the pharmacy. Patient adherence increases and pharmacies can keep tighter control over inventory while having more efficient workflow. NCPA promotes the improved adherence and quality of […]
What do Jublia® (efinaconazole), ciclopirox (formerly Penlac®), and tavaborole (formerly Kerydin®) all have in common? Besides each being a topical solution for the treatment of onychomycosis (Jublia® and Kerydin® for toenails and Penlac® for fingernails and toenails), they also all require knowing the number of applications per bottle for calculating an accurate days’ supply. Unfortunately, manufacturers do not provide […]
There have been some updates to the continuous glucose monitor (CGM) world since our last Newsline article released March 2024. Abbott has released two new sensors, FreeStyle Libre 2 Plus Sensor and FreeStyle Libre 3 Plus Sensor, that can be used with the FreeStyle Libre 2 Reader and FreeStyle Libre 3 Reader, respectively. FreeStyle Libre […]
When a pharmacy dispenses a quantity other than what was prescribed, it requires documentation. PBMs will want to know the rationale, whether the quantity was increased or decreased. There are plenty of valid reasons a pharmacy may need to change the quantity, including …
Pharmacies often work in a fast-paced environment with an increasing workload as we see stores closing, more transfer-ins, and higher patient demand. This results in an increased urgency to perform data entry faster, which can lead to the use of override codes to get the claim adjudicated quickly. PAAS National®® is here to remind pharmacies […]
Billing the wrong NDC can correlate to potential audit issues, ranging from recoupments on claims to risking contract termination. In fact, poor performance on invoice audits due to the pharmacy billing the incorrect NDC (in relation to the NDC dispensed), is a leading reason pharmacy contracts get terminated. This issue can be mitigated by …
