Prescription topical medications play a vital role in managing various skin conditions. Topical medications are widely available for acne treatments, anti-inflammatory, antifungals, antibiotics, pain relievers and more. However, the lucrative nature of these products has unfortunately created opportunities for improper billing. Keeping topical medication prescriptions under watch is imperative to avoid potential overpayments.
What to Look for?
We’ve long known about telemarketing schemes involving unsolicited phone calls to beneficiaries. Despite diligent work to stop improper dispensing of these items, this trend continues today. Lidocaine patches have been targets of FWA through many different telemarketing schemes and due to the vast number of different brand names and different strengths, it can feel like a constant moving target. These topical drugs may be issued by a beneficiary’s prescriber at the pharmacy’s request, or they may be authorized by prescribers with no relationship to the pharmacy or the beneficiary.
Another area of concern for improper billing is excessive dispensing of a particular drug by a pharmacy. This can be seen with high-cost creams, ointments and/or expensive compounded medications. Some of the recently highlighted creams by CMS are permethrin cream and lidocaine/prilocaine cream. Permethrin cream is used to treat scabies and lice for patients at least 2 years old.[1] Excessive billing of these creams, along with others, can be a precursor to emerging telemarketing schemes. Additionally, instances of overprescribing could point towards possible collusion between the drug company and the prescriber.
HCFS has you covered!
If you’re using the HCFSPlatform™, we have you covered. We have several alerts to target possible collusion related to topical medications as well as over prescribing and/or over dispensing. Some of the most recent peer comparison alert additions are:
[5313-20] and [5313-21] – COLLUSION, TOPICAL TELEMARKETING SCHEME, PERMETHRIN CREAM 5%:
[5314-20] and [5314-21] – COLLUSION, TOPICAL TELEMARKETING SCHEME, LIDOCAINE/PRILOCAINE CREAM 2.5%
[5345-20] and [5345-21] – OUTLIER BY PRESCRIBER, LIDOCAN PATCH 5%
These Alerts paired with our Pharmacy Artificial Intelligence (AI) models can help identify collusion, suspicious prescribing patterns and billing anomalies. Did you also know the HCFSPlatform™ incorporates a number of public record data sources that assist with Pharmacy related FWA into QueryShield, our ad-hoc Query and Reporting tool which enables users to run real-time queries and complex pattern reports? These reports can also be placed on a schedule to run automatically at any given interval.
If you have questions or comments, email us at [email protected].
References:
[1] https://www.webmd.com/drugs/2/drug-5964-8063/permethrin-topical/permethrin-cream-topical/details
If you’re not using the HCFSPlatform™, make 2025 your year! If you’re interested in knowing more, email us at [email protected]