Relating To Pharmacy Audits.
Should it become law, SB975 would amend Chapter 431R of the Hawaii Revised Statutes to create a structured process for pharmacy audits. The legislation mandates that any audit involving clinical judgments must involve a licensed pharmacist and cuts out the use of extrapolation when determining penalties or recoupments. This approach aims to make auditing practices fairer and less punitive, thus protecting pharmacies from arbitrary financial scrutiny and maintaining accessibility for consumers seeking pharmaceutical care. Moreover, the provisions of the bill include a clear appeals process, ensuring that pharmacies have the opportunity to contest unfavorable findings.
SB975, titled relating to Pharmacy Audits, aims to introduce regulations governing the auditing processes carried out by pharmacy benefit managers (PBMs) and insurance providers. This bill arises from concerns that pharmacies currently face unjust and unregulated audits, often leading to substantial penalties. By establishing specific rules for audits, SB975 endeavors to protect consumer access to pharmacy benefits and provide clarity on how audits should be conducted, thus addressing a significant gap in the existing legal framework.
The sentiment around SB975 is generally supportive among pharmacy owners and advocates for consumer rights, who view the bill as a necessary step toward preventing abusive audit practices. Proponents believe it offers crucial protections that have been implemented successfully in many other states, thus fostering a fairer business environment. However, some stakeholders, particularly within the insurance industry, express concern about the bill's potential to complicate audit processes and affect their ability to manage drug costs effectively.
Notable points of contention regarding SB975 include the balance it seeks between fair auditing and the operational needs of PBMs and insurance providers. Critics of the bill have raised issues about the potential increase in costs for these entities, arguing that the stringent regulations could inhibit their ability to conduct thorough audits necessary for fraud prevention and cost control. The debate emphasizes the ongoing tension between safeguarding consumer access and ensuring that auditing authorities can operate effectively without compromising financial oversight.