H.B. No. 1455
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 according to the prescription; and
(3) the drug dispensed by the pharmacist or pharmacy
shares all but the last two digits of the National Drug Code of the
drug reflected on the supplier invoice.
(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) subject to validation, including validation by
pharmacy purchase order and payment of a supplier invoice, 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 not earlier than 60 days before the first day
of the audit period; and
(B) invoices and any supporting documents from
any supplier authorized by federal or state law 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 the date
of 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.
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.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1455 was passed by the House on April
24, 2019, by the following vote: Yeas 147, Nays 0, 1 present, not
voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 1455 was passed by the Senate on May
19, 2019, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor