Relating to the audit of wholesale invoices during certain audits of pharmacists and pharmacies.
If enacted, HB1455 would significantly impact existing laws related to pharmacy audits, creating a more structured approach to how health benefit plans and pharmacy benefit managers can conduct audits. It mandates that any discrepancies found in audits must be reversed if certain conditions regarding the dispensed drugs are met. This change seeks to protect pharmacists from unjust penalties and enhance the accountability of health benefit entities in their auditing processes.
House Bill 1455 aims to regulate the auditing practices of health benefit plan issuers and pharmacy benefit managers concerning wholesale invoices during pharmacy audits. The legislation specifically prohibits these entities from auditing claims submitted to another health benefit plan or pharmacy benefit manager. The intent is to provide clearer guidelines and protections for pharmacists during the audit process, reducing potential discrepancies and misunderstandings between pharmacies and health plans regarding dispensed medications.
The sentiment surrounding HB1455 appears to be largely supportive among pharmacists and pharmacy advocates, who view the bill as a necessary step toward ensuring fair treatment and improving transparency in the auditing process. There seems to be a recognition that the current auditing practices may place an undue burden on pharmacies, making this legislation a favorable development. However, there may be concerns among health benefit plans regarding how these changes could affect their operations and overall auditing efficacy.
Notable points of contention surrounding HB1455 include the potential limitation of audit powers for health benefit plan issuers and pharmacy benefit managers. Critics may argue that while the bill seeks to protect pharmacists, it could hinder necessary oversight of pharmacy practices. Furthermore, the nuances of compliance and enforcement of the new provisions may raise questions on whether the bill adequately addresses all potential audit scenarios while balancing the interests of both pharmacists and health benefit providers.