Poster: Evaluating ICD Codes on Pharmacy Claim Submissions: Are They Reliable?

Capital Rx's Zachary Brunko, PharmD (PGY1 Managed Care Resident), Jackie Lolos (Manager, Formulary Operations), and Nisha Bhide (Senior Director, Formulary Operations) conducted a study seeking to evaluate the accuracy and reliability of ICD codes submitted on pharmacy claims. Additionally, they sought to identify patterns in ICD code submissions across client types, drug classes, disease states, pharmacy networks, and regions.

The team presented their research findings at the AMCP 2025 Annual Conference. Review or download the poster below to see their findings.