| 1 | 1 | | 86R888 LED-F |
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| 2 | 2 | | By: Buckingham S.B. No. 692 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to the audit of wholesale invoices during certain audits |
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| 8 | 8 | | of pharmacists and pharmacies. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Subchapter F, Chapter 1369, Insurance Code, is |
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| 11 | 11 | | amended by adding Section 1369.2581 to read as follows: |
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| 12 | 12 | | Sec. 1369.2581. AUDIT DISCREPANCIES; WHOLESALE INVOICES. |
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| 13 | 13 | | (a) A health benefit plan issuer or pharmacy benefit manager that |
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| 14 | 14 | | audits wholesale invoices during an audit of a pharmacist or |
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| 15 | 15 | | pharmacy may not audit the pharmacy claims of another health |
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| 16 | 16 | | benefit plan or pharmacy benefit manager. |
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| 17 | 17 | | (b) A health benefit plan issuer or pharmacy benefit manager |
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| 18 | 18 | | shall reverse a finding of a discrepancy if: |
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| 19 | 19 | | (1) the National Drug Code for the dispensed drug is in |
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| 20 | 20 | | a quantity that is a subunit or multiple of the drug purchased by |
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| 21 | 21 | | the pharmacist or pharmacy as supported by a wholesale invoice; |
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| 22 | 22 | | (2) the pharmacist or pharmacy dispensed the correct |
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| 23 | 23 | | quantity of the drug; and |
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| 24 | 24 | | (3) the dispensed drug is identical in strength and |
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| 25 | 25 | | dosage to the drug purchased by the pharmacist or pharmacy from the |
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| 26 | 26 | | wholesaler. |
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| 27 | 27 | | (c) A health benefit plan issuer or pharmacy benefit manager |
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| 28 | 28 | | must accept as evidence to support the validity of a pharmacy claim |
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| 29 | 29 | | related to a dispensed drug: |
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| 30 | 30 | | (1) copies of supplier invoices in the pharmacist's or |
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| 31 | 31 | | pharmacy's possession, including: |
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| 32 | 32 | | (A) supplier invoices issued before the date the |
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| 33 | 33 | | drug was dispensed; and |
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| 34 | 34 | | (B) invoices from any supplier authorized to |
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| 35 | 35 | | transfer ownership of the drug acquired by the pharmacist or |
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| 36 | 36 | | pharmacy; and |
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| 37 | 37 | | (2) reports required by any state board or agency. |
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| 38 | 38 | | (d) A health benefit plan issuer or pharmacy benefit manager |
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| 39 | 39 | | must provide, not later than the fifth business day after a request |
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| 40 | 40 | | by the pharmacist or pharmacy, any supporting documents the |
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| 41 | 41 | | pharmacist's or pharmacy's suppliers provided to the health benefit |
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| 42 | 42 | | plan issuer or pharmacy benefit manager. |
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| 43 | 43 | | (e) A health benefit plan issuer or pharmacy benefit manager |
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| 44 | 44 | | may not recoup any amount based on a wholesale invoice discrepancy |
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| 45 | 45 | | regarding the patient's receipt of a dispensed drug if the audited |
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| 46 | 46 | | pharmacy claim is supported by records of the pharmacist or |
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| 47 | 47 | | pharmacy showing that the patient or patient's agent received the |
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| 48 | 48 | | dispensed drug underlying the audited pharmacy claim. |
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| 49 | 49 | | SECTION 2. The changes in law made by this Act apply only to |
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| 50 | 50 | | an audit conducted under a contract between a pharmacist or |
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| 51 | 51 | | pharmacy and a health benefit plan issuer or pharmacy benefit |
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| 52 | 52 | | manager entered into, amended, or renewed on or after the effective |
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| 53 | 53 | | date of this Act. |
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| 54 | 54 | | SECTION 3. This Act takes effect September 1, 2019. |
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