Pharmacy benefit managers; establishing requirements and limits for certain audit reports and findings. Emergency.
The enactment of SB993 is poised to alter how PBMs conduct audits and will enforce stricter compliance standards. The bill mandates that audit entities must provide adequate notice before initiating an audit while also ensuring that discrepancies arising from clerical errors or record-keeping mistakes are not classified as fraud without clear intent. Additionally, it imposes limits on the number of claims that can be audited and specifies the duration of audits in compliance with disaster declarations, providing additional protections to pharmacies during such times.
Senate Bill 993 introduces significant changes to the regulation of pharmacy benefits managers (PBMs) in Oklahoma, specifically by establishing requirements and limits regarding audits of pharmacies. The bill outlines a unified framework for auditing efforts, aiming to protect pharmacies from unfair audit practices and ensuring transparency in the audit process. This includes provisions for notifying pharmacies prior to audits, establishing specific timelines for audit report submissions, and prohibiting punitive financial measures against pharmacies unless there is a valid recoupment under existing laws.
The sentiment surrounding SB993 appears to be largely supportive among pharmacies and many healthcare advocates, who view it as a necessary step toward fairer practices within the pharmaceutical industry. However, certain stakeholders, particularly larger PBMs, may perceive the bill as overregulation that could limit their operational flexibility. The legislative discourse reflects concerns about balancing appropriate oversight with the need for business efficiency in pharmacy operations.
Notably, there are areas of contention regarding the bill. Critics argue that while the bill enhances protections for pharmacies, it may introduce bureaucratic hurdles for PBMs that could affect overall efficiency in managing pharmacy claims. Furthermore, there are concerns about the bill’s potential impact on the reimbursement process and how it could complicate relationships between pharmacies, PBMs, and health plan providers. The ongoing debate signifies the tension between ensuring accountability for PBMs while also safeguarding the interests of pharmacies and their operations.