PAAS Tips: Prescribers may try to help patients get around plan exclusions for weight loss medications by prescribing Ozempic or Victoza at higher doses o FDA approved medications being used off-label like this would likely not be covered under federal programs and are subject to audit recoupment o Claims paid at point-of-sale do not guarantee payment If a prescription is written for the Analog name, pharmacies need to confirm the diagnosis to bill the correct medication These products come in multiple strengths and package sizes which would also need to be confirmed Medicare Part D and Medicaid may restrict coverage of medications if the prescribed use is not for a medically accepted indication PAAS Audit Assistance members can view our May 2021 Newsline article, New Package Size Available for Ozempic for reference on how to bill for Ozempic
UK supplier
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A few commenters suggested we make updates to the requirements for displaying shoppable services in a consumer-friendly manner at 180.60, with some of these commenters indicating we should eliminate these requirements as they feel they are no longer necessary as a result of the TiC and NSA regulations
Food and Drug Administration (FDA) DailyMed Label: Bacteriostatic Water for Injection (Provides official labeling, storage instructions, and preservative information) United States Pharmacopeia (USP) USPNF General Chapters & Monographs (Defines standards for sterile water for injection and pharmaceutical quality requirements) World Health Organization (WHO) WHO Good Storage and Distribution Practices (Guidelines for temperature control, sterility, and pharmaceutical handling) American Society of Health-System Pharmacists (ASHP) (Clinical guidance on sterile product handling and multi-dose vial use) FDA Guidance on Sterile Drug Products (Aseptic handling, contamination risk, and storage principles)
A practical summary of management of hypertriglyceridaemia is presented in Table XXII
