86R888 LED-F
By: Hunter H.B. No. 1455
A BILL TO BE ENTITLED
AN ACT
relating to the audit of wholesale invoices during certain audits
of pharmacists and pharmacies.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter F, Chapter 1369, Insurance Code, is
amended by adding Section 1369.2581 to read as follows:
Sec. 1369.2581. AUDIT DISCREPANCIES; WHOLESALE INVOICES.
(a) A health benefit plan issuer or pharmacy benefit manager that
audits wholesale invoices during an audit of a pharmacist or
pharmacy may not audit the pharmacy claims of another health
benefit plan or pharmacy benefit manager.
(b) A health benefit plan issuer or pharmacy benefit manager
shall reverse a finding of a discrepancy if:
(1) the National Drug Code for the dispensed drug is in
a quantity that is a subunit or multiple of the drug purchased by
the pharmacist or pharmacy as supported by a wholesale invoice;
(2) the pharmacist or pharmacy dispensed the correct
quantity of the drug; and
(3) the dispensed drug is identical in strength and
dosage to the drug purchased by the pharmacist or pharmacy from the
wholesaler.
(c) A health benefit plan issuer or pharmacy benefit manager
must accept as evidence to support the validity of a pharmacy claim
related to a dispensed drug:
(1) copies of supplier invoices in the pharmacist's or
pharmacy's possession, including:
(A) supplier invoices issued before the date the
drug was dispensed; and
(B) invoices from any supplier authorized to
transfer ownership of the drug acquired by the pharmacist or
pharmacy; and
(2) reports required by any state board or agency.
(d) A health benefit plan issuer or pharmacy benefit manager
must provide, not later than the fifth business day after a request
by the pharmacist or pharmacy, any supporting documents the
pharmacist's or pharmacy's suppliers provided to the health benefit
plan issuer or pharmacy benefit manager.
(e) A health benefit plan issuer or pharmacy benefit manager
may not recoup any amount based on a wholesale invoice discrepancy
regarding the patient's receipt of a dispensed drug if the audited
pharmacy claim is supported by records of the pharmacist or
pharmacy showing that the patient or patient's agent received the
dispensed drug underlying the audited pharmacy claim.
SECTION 2. The changes in law made by this Act apply only to
an audit conducted under a contract between a pharmacist or
pharmacy and a health benefit plan issuer or pharmacy benefit
manager entered into, amended, or renewed on or after the effective
date of this Act.
SECTION 3. This Act takes effect September 1, 2019.