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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

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