Relating To Pharmacy Audits.
By implementing specific procedures for auditing pharmacies, the bill is expected to enhance the legal framework governing pharmacy audits in Hawaii, aligning with similar legislation enacted in thirty-eight other states. It establishes requirements for preliminary notifications before audits, stipulates that clinical or professional judgments in audits must involve a licensed pharmacist, and restricts the audit period to claims made within the past year. This ensures that audits are conducted in a manner that respects the rights and practices of pharmacies while emphasizing consumer protection.
House Bill 1134 aims to establish comprehensive regulations governing the audits of pharmacies conducted by pharmacy benefit managers (PBMs) and insurance providers in Hawaii. The bill was introduced to address the existing lack of regulations in this area, which has allowed PBMs to enforce audits unilaterally, often resulting in severe penalties and fees for pharmacies. The proposed legislation seeks to standardize the audit process and ensure that it is fair and transparent, particularly protecting pharmacies from potentially abusive practices that may compromise consumer access to pharmacy benefits.
Despite its protective intentions, the bill may face opposition from some insurance providers who might resist regulatory oversight. Concerns could arise regarding the implementation and administrative burden of these regulations, potentially leading to disputes about audit practices. Critics may argue that excessive regulation could hinder the operational efficiency of PBMs and increase costs for insurance companies, which could ultimately affect healthcare pricing structures and availability of benefits.