What is the correct way to bill an insurance company for a taper?

by Stacy
(Portland, Oregon, USA)

Taper of Sertraline -- Best way to Adjudicate Rx Taper

Taper of Sertraline -- Best way to Adjudicate Rx Taper

What would be the correct way to submit the days supply to the patient's insurance for a tapering medication?

For example, if the rx says zolft 25mg qd for 7 days, then increase to 2 tabs thereafter, dispense 60 tabs.

Would you do 30 days going with the 2 qd or would you bill 33 days calculating the 1qd for 7 days?

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53 tablets for 30 days on this Sertraline 25mg Taper
by: David

You would (and should) bill the insurance for a 33 days supply. However, most insurance companies usually require that only a maximum of a 30 day supply be billed.

So, for this example, how many pills would a 30-day supply be?

Sertraline 25mg, 1 tablet po qd for 7 days, then 2 tablets (50mg) po daily.

30 days supply - 7 (first seven days on taper) = 23 remaining days

23 days, multiplied by 2 (2 tabs daily) = 46

7 days (7 pills) + 23 days (46 pills) = 30 days (53 total pills)

NOTE: After the first 30 days of the taper, the insurance company may require that the Sertraline taper change to a once daily 50mg tablet moving forward. In this case, it would be 30 tablets for a 30 days supply.

NOTE: After the first 30 days of the taper, if the insurance company does NOT require that the rx be changed to 50mg tabs 30 pills for a 30 DS, and they allow 2-25mg tabs, the days supply will need to be changed from the 53 tabs for 30 days TO 60 tabs for 30 days supply.

Thanks for the question!



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