An Act Concerning Pharmacy Audits And Electronic Funds Transfer Payments To Pharmacies.
Impact
With the passage of SB00014, significant changes were made to the existing statutes governing pharmacy audits. The bill repeals several previous provisions and introduces clearer definitions and guidelines for the conduct of audits. It states that only PBMs or plan sponsors may conduct audits, thereby centralizing and regulating the auditing process to ensure that it is carried out justly. By restricting the timeframes within which audits can be conducted and the conditions under which they may operate, the bill aims to protect pharmacies from potentially disruptive auditing practices that could affect their financial stability.
Summary
Senate Bill No. 14, known as An Act Concerning Pharmacy Audits and Electronic Funds Transfer Payments to Pharmacies, seeks to regulate the practices surrounding pharmacy audits in Connecticut. The legislation mandates that pharmacy benefits managers (PBMs) must adhere to specific protocols when conducting audits, including advance notice to pharmacies and limits on the auditing period. This regulation aims to create a fairer environment for pharmacies, ensuring that audits are conducted with transparency and accountability while safeguarding pharmacies from unfair practices during the audit process.
Sentiment
The general sentiment surrounding the bill was supportive, reflecting the necessity for better oversight and regulation in the auditing process. Lawmakers, particularly those representing pharmacy interests, voiced strong approval, advocating that the new measures would alleviate burdens on pharmacies and ensure fair treatment in audit scenarios. Critics, however, expressed some concerns about the practicality of the new regulations and whether they would effectively deter malpractice while still allowing adequate oversight of financial discrepancies in healthcare claims.
Contention
Notable points of contention included the definitions and scope of what constitutes a pharmacy audit, as well as the discretion afforded to PBMs during the audit process. Some stakeholders argued that the measure might not go far enough to prevent all forms of abuses that could occur under the various interpretations of audit practices. Additionally, the bill's implications on the financial liabilities of pharmacies and their ability to defend against audits were debated, highlighting concerns over the potential for vague provisions that could still leave pharmacies vulnerable.
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A bill for an act relating to pharmacy benefits managers, pharmacies, prescription drugs, and pharmacy services administrative organizations, and including applicability provisions. (Formerly SSB 1074.) Effective date: 07/01/2025. Applicability date: 07/01/2025.