It is great that the feds identified this problem and charged the responsible parties – however, this never should have happened. Compounded prescriptions have long been an easy way for pharmacies to game the system.
There are some very simple ways to thwart this. At a minimum the pharmacy benefit manager (PBM) should follow these guidelines to prevent prescription drug fraud:
Set all compounds over $100 to PA.
Verify diagnosis with prescriber.
Exclude repackaged ingredients that can have artificially inflated AWPs.
Set MAC price for common active ingredients.
Do not cover if the active ingredient is not approved for the route of administration.
Do not cover if the active ingredient does not require a prescription at the prescribed dose or concentrations.
If the PBM is not willing to implement these measures, it is because they are either incompetent or they are making spread on the compound and profiting from the questionable tactics described in the article.
In a recent article in the Bristol Herald Courier, David Balto gives a great summary of the problems with the pharmacy benefit management industry, such
“Today, one in four Americans who need prescription drugs struggle to afford them — one in four,” president Joe Biden. The last two administrations have
Shopping Basket
More Information?
Fill out your details and we will get back to you as soon as possible.
Preventing Prescription Drug Fraud
Recommended Reading: Florida pharmacy owner found guilty of running $174M telehealth fraud scheme
It is great that the feds identified this problem and charged the responsible parties – however, this never should have happened. Compounded prescriptions have long been an easy way for pharmacies to game the system.
There are some very simple ways to thwart this. At a minimum the pharmacy benefit manager (PBM) should follow these guidelines to prevent prescription drug fraud:
If the PBM is not willing to implement these measures, it is because they are either incompetent or they are making spread on the compound and profiting from the questionable tactics described in the article.
See more news
Government Solution Not Needed to Reduce Drug Costs
In a recent article in the Bristol Herald Courier, David Balto gives a great summary of the problems with the pharmacy benefit management industry, such
Transparent Pharmacy Benefits Are Possible
In a recent article at BenefitsPRO, Dan Cook talks about the movement to have employers “rise up and fight their own battles with the drug
The Real Issues With Prescription Drug Costs
“Today, one in four Americans who need prescription drugs struggle to afford them — one in four,” president Joe Biden. The last two administrations have