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October 2014
Are you billing correctly for these drugs?
The following drugs are often billed with incorrect quantities under the prescription drug benefit. Review the charts below for the appropriate quantities of these drugs so your claims can be processed more accurately and promptly.
Drug name |
Incorrect quantity |
Correct quantity |
Enbrel®
Example:
50 mg per 0.98 mL (4 syringes) |
4 syringes |
3.92 mL total volume
(4 x 0.98 mL) |
Androgel® pump
Example: 88 gm pump delivering 75 gm of gel |
88 gm pump |
75 gm of gel |
Premarin®; vaginal cream
Example: 0.625 mg per gm, 30 gm tube |
42.50 gm |
30 gm |
Clobex® (Clobetasol Propionate)
Example: 0.05%; 4 oz bottle |
120 mL
or
60 mL |
118 mL
or
59 mL |
Hydrocortisone
Example: 2.5% cream in 28.35 gm tube or 453.6 gm jar |
30 gm
or
454 gm |
28.35 gm (exact weight)
or
453.6 gm (exact weight) |
Lactulose
Example: 10 g per15 mL (1 pint bottle) |
480 mL |
473 mL |
Victoza® is a drug that is often billed with incorrect quantities. See the chart below for the accurate information.
Dose |
Day’s supply per pen |
Package (bill by volume) |
Day’s supply per package |
0.6 mg per day |
15 |
6 mL (2 pens) |
30 |
9 mL (3 pens) |
45 |
1.2 mg per day |
10 |
6 mL (2 pens) |
20 |
9 mL (3 pens) |
30 |
1.8 mg per day |
5 |
6 mL (2 pens) |
10 |
9 mL (3 pens) |
15 |
For any questions on how to submit claims, call our claims processor, Express Scripts®, at 1-800-922-1557. If you have questions about this article, call our Pharmacy Services Clinical Help Desk at 1-800-437-3803. | 