Walgreens was caught multiple times defrauding. A few years ago, they were dispensing Fluoxetine tabs instead of caps so they could get higher reimbursement from Medicaid. They paid a huge fine and admitted wrongdoing
Again, thats totally different from insulin boxes. I don't know why you keep throwing out random examples that have nothing to do with your argument. Here are the guidelines from medco/express scripts (the largest PBM) for insulin boxes:
The submitted NDC must be the complete NDC of the medication dispensed, including the package size. For example, if ten (10) or more vials of Pergonal® or similar products are dispensed at one time, the NDC number of the 10-pack must be submitted. Drug products contained in “unbreakable” packages as determined by the FDA must be in their original packaging and dispensed as a whole unit. Examples include oral contraceptives, Accutane 10-packs, etc. The Network Provider must use actual metric package sizes when available. If the metric measurement is not available, the following standard conversions should be used:
o One fluid ounce = 30 ml.
o One pint = 480 ml.
o One liter = 1000 ml.
o One ounce = 30 g.
o One pound = 454 g.
2.13 Days Supply
The exact number of consecutive days supply must be submitted, with the calculation based on the metric quantity prescribed and the Prescriber’s exact written directions. If the Prescriber does not provide exact directions, or writes “as directed” or “prn”, or writes directions where a consecutive days supply cannot be calculated, Network Provider must call the Prescriber or ask the Member for the directions, document such directions on the prescription, initial the same, and submit the exact days supply based on those directions and the quantity prescribed. Prescriber’s signature on the prescription does not translate into an assumed days supply. Stated another way, days supply must always be calculated based on the information on the prescription and must never be assumed.
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However, the following exceptions are listed under "6.5 Discrepancy Glossary:"
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For products dispensed in unit of use packaging, allow for “as directed” with the following guidelines:
• If no specific quantity indicated, Network Provider must call Prescriber for quantity or directions for use to calculate quantity.
• If specific quantity is given and the smallest available package size is prescribed, dispense with “as directed” for a 30-day supply. If quantity indicated is not smallest package size, the Network Provider must document directions for use.
• As Directed may be used in the following conditions (all others require specific directions)
o Test Strips and Lancets – one box of 100 for 30 days
o Insulin Vials – up to 2 vials for a 30-day supply
o Insulin Syringes – 1 box of 100 for a 30-day supply (or 9 packages of 10)
o Insulin Cartridges/Pens – 1 box for 30 days
o Pen Needles – 1 box for 30 days
For oral solids dispensed as individual tablets, specific directions for use are required, except:
• Warfarin products: If dispensed as a 1 for 1 ratio, dispense with “as directed” (e.g. 30 for 30 days, 90 for 90 days)
• Steroids: When directions are “as directed per tapering dose,”
• All oral solids dispensed in manufacturer’s original packaging must have directions for use except:
o Drugs on current Quantity Level Limits (QLL) list (e.g. Viagra, Imitrex). If QLL is exceeded, must have directions for use.
o Manufacturers’ packaging has pre-printed patient instructions (e.g. Fosamax).
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Back to "2.13 Days Supply"
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Should the days supply submitted exceed the Sponsor’s Prescription Drug Program’s limitation, Network Provider will receive a “days limit = ‘x’ ” online message. Please do not reduce days supply without also reducing quantity. In such case, based on the Prescriber’s directions, reduce the quantity dispensed to the Member proportional with the reduction in days. Failure to reduce a quantity when reducing a days supply may result in a recoupment of the over-billed amount upon audit.
Okay? Can you stfu. They are saying it's okay. Move on.
