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November 2017
Are you billing correctly for these drugs?
We often receive bills for the following drugs with incorrect quantities under the prescription drug benefit. To ensure that your claims are accurate and processed in timely manner, refer to the tables below. Drugs are listed by their name and strength.
Drug name
and billed example |
Incorrectly billed quantity |
Correctly billed quantity |
Avonex®
30 mcg/0.5 mL
(4 syringes) |
4 (number of syringes) |
2.0 mL = total volume
(4 x 0.5 mL) |
Enbrel Sureclick®Autoinjector
50 mg/mL (4 autoinjectors) |
3.92 (number of mL in different Enbrel product) |
4.0 mL = total volume
(4 x 1 mL) |
Humulin R®
500 units/ml vial |
100 (units) |
40 mL = total volume
(2 x 20 mL; 500 units/mL) |
Medications often associated with incorrect days' supply
Restasis®
Package size
(bill by vial) |
Dosing |
Days’ supply |
Incorrectly billed quantity |
Correctly billed quantity |
30 single-use vials
(0.4 mL each) |
One drop in each eye q12h
(2 vials per day) |
1 package for 15 days |
120 or 180 vials
for 30 days |
30 vials
for 15 days |
60 (2 x 30) single-use vials (0.4 mL each) |
One drop in each eye q12h
(2 vials per day) |
1 package for 30 days |
120 or 180 vials
for 30 days |
60 vials
for 30 days |
Spiriva® 18 MCG CP-HandiHaler®
Dosing |
Package size
(bill by capsules) |
How many inhalations per package? |
18 mcg |
30 caps |
30 caps = 30 inhalations per package |
Spiriva® 18 MCG CP-HandiHaler® = |
#caps in box |
= days’ supply |
| |
# inhalations presribed 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 |
If you have questions about drug claims, contact our claims processor Express Scripts at 1-800-922-1557.
For any questions about the information in this article, contact our Pharmacy Services Clinical Help Desk at 1-800-437-3803. | 
