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October 2016
Are you billing correctly for these drugs?
For the following drugs, we often receive bills with incorrect quantities under the prescription drug benefit. To help you submit the appropriate quantities on claims for these medications, we've listed the correct quantities below. We can process your claims more accurately and quickly when you provide accurate quantities.
Drug name |
Incorrectly billed quantity |
Correctly billed quantity |
Avonex®
Example: 30 mcg/0.5 mL
(4 syringes) |
4 syringes |
2 mL = total volume
(4 x 0.5 mL) |
Chorionic gonadotropin
Example: 10,000 USP units per 10 mL vial |
20 mL |
2 vials |
Enbrel®
Example: 50 mg/0.98 mL
(4 syringes) |
4 syringes |
3.92 = total volume
(4 x 0.98 mL) |
Premarin® vaginal cream
Example: 0.625 mg/gm; 30gm tube |
42.50 gm |
30 gm |
Enoxaparin
Drug name |
Incorrectly billed quantity |
Correctly billed quantity |
Enoxaparin
Example: 40 mg/0.4 mL
(1 syringe) |
60 syringes |
24 mL = total volume
(60 x 0.4 mL) |
Enoxaparin
Example: 40 mg/0.4 mL
(1 syringe) |
30 syringes |
12 mL=total volume
(30 x 0.4 mL) |
Medications often associated with incorrect days' supply:
Alrex 0.2% eye drops
Dosing |
Package size
(bill by volume) |
Quantity of drops per bottle |
0.2% |
5 mL |
5 mL x 20 drops/mL = 100 drops in bottle |
0.2% |
10 mL |
10 mL x 20 drops/mL = 200 drops in bottle |
Alrex 0.2% ophthalmic suspension=
Number drops in bottle |
= day supply |
Number drops prescribed per day |
Victoza®
Dose |
Days' supply per pen |
Package
(bill by volume) |
Days’ supply per package |
0.6 mg per day |
30 |
6 mL (2 pens) |
60 |
9 mL (3 pens) |
90 |
1.2 mg per day |
15 |
6 mL (2 pens) |
30 |
9 mL (3 pens) |
45 |
1.8 mg per day |
10 |
6 mL (2 pens) |
20 |
9 mL (3 pens) |
30 |
Questions?
Call our claims processor, Express Scripts, at 1-800-922-1557. If you need additional support, call our Pharmacy Services Clinical Help Desk at 1-800-437-3803. | 