DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part of the
legislative instrument. The keyword, one-liner, abstract, and digest do not constitute part of the law
or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 538 Original 2019 Regular Session LeBas
Abstract: Provides relative to the audit of pharmacy records.
Present law provides the criteria for the auditing of pharmacy records including the protocol for
conducting an onsite audit and a prohibition against an audit taking place within the first five days
of a month.
Proposed law repeals the requirement for onsite audits as they relate to the auditing of pharmacy
records.
Present law requires any audit involving clinical judgment be conducted by or in consultation with
a pharmacist.
Proposed law changes present law to require that any audit of a pharmacy with its principle place of
business within this state be conducted by a pharmacist licensed in La.
Present law provides that no pharmacy be subject to recoupment of any portion of the reimbursement
for the dispensed product of a prescription unless one or more conditions occur.
Proposed law changes present law by requiring that the condition occur at the point of adjudication.
Present law provides that recoupment of claims be based on the actual financial harm to the entity,
or on the actual overpayment or underpayment.
Proposed law changes present law by requiring that such financial harm exist at the point of
adjudication.
Proposed law provides that if any entity determines that the processed or adjudicated claim of a
pharmacy qualifies for recoupment based upon the use of a manufacturer coupon or copay card, such
recoupment shall come from the beneficiary of the reduction.
Present law provides that present law does not apply to any federally funded activity, specifically
preempted by law or rule or any audit conducted pursuant to the participation of a pharmacy in the
Louisiana Medicaid Program. Proposed law repeals present law.
(Amends R.S. 22:1856.1; Adds R.S. 22:1856.1(D)(3); Repeals 22:1856.1(G)(3) and (4))