Pharmacies know Ozempic^® prescriptions have been on PBM radars since they were first released. Not only are these high dollar claims, but they are an easy target for incorrect billing. Making a simple days’ supply error on an Ozempic^® claim can result in thousands of dollars being recouped. 

Two common days’ supply errors occur with the initial titration dose and patients remaining on the 0.25 mg weekly dose. Billing either one of these incorrectly may cause refill claims to pay earlier than they should. Each early refill is subject to full recoupment.

A safe way of handling titration prescriptions is to create two prescriptions tied to the same originating order. One for the initial fill only, and a second prescription that contains the maintenance dose instructions. This allows you to bill each prescription claim accurately, without needing to change any billing information on refills. By creating a maintenance dose prescription, it may also prevent prescribers from continuing to send prescriptions with the initial titration instructions. Should you receive a prescription with a titration after the patient is on a maintenance dose, it’s best to call the prescriber, confirm the maintenance dose, and update the prescription SIG with a clinical note.

PAAS Tips:

• Self-Audit your Ozempic^® prescriptions weekly/monthly to ensure accurate billing
• Monitor patients Ozempic^® fill history and document when initial titrations are complete
• Watch for prescriptions with old pen size of 1.5 mL, these should be re-authorized by the prescriber for the 3 mL pen

By Trenton Thiede, PharmD, MBA, President at PAAS National^®