Pharmacy benefit managers; establishing requirements and limits for certain audit reports and findings. Emergency.
The proposed changes are expected to have a significant impact on state pharmacy laws and practices regarding auditing. By regulating how audits are conducted and setting standards for reporting findings, SB993 intends to create a more equitable environment for pharmacies, enabling them to defend themselves effectively against potentially wrongful accusations of fraud or discrepancies. The requirement for timely communication of audit results and adherence to strict notification protocols aims to enhance transparency and fairness during the audit process.
Senate Bill 993 (SB993), known as the Pharmacy Audit Integrity Act, seeks to establish minimum standards and requirements for the auditing of pharmacies by pharmacy benefits managers (PBMs). One of the primary intentions of this bill is to protect pharmacies from excessive and potentially harmful audit practices. It introduces several changes to the audit process, notably prohibiting extrapolation audits that estimate results from a sample rather than assessing each claim individually. This change aims to ensure that pharmacies are not unfairly penalized based on isolated discrepancies that may not reflect larger issues.
The general sentiment surrounding SB993 seems to be largely supportive, particularly among pharmacy owners and advocates for pharmacy autonomy. Supporters emphasize the need for balance in regulatory practices, citing that existing audit practices often lead to unjustified financial penalties on pharmacies. However, there are concerns about whether the adjustments may lead to reduced oversight capabilities for PBMs, which could allow some instances of fraud to persist unchecked.
Notable points of contention include the debate over the elimination of extrapolation audits versus the necessity of stringent oversight of pharmacies to prevent fraud. Critics of the bill argue that while protections for pharmacies are essential, it is also crucial to maintain mechanisms that deter fraudulent activities by these businesses. The discussion highlights the ongoing struggle between regulatory oversight and the protection of pharmacies' interests in a complex healthcare environment.