Bill Text: TX HB1455 | 2019-2020 | 86th Legislature | Enrolled
Bill Title: Relating to the audit of wholesale invoices during certain audits of pharmacists and pharmacies.
Spectrum: Moderate Partisan Bill (Republican 8-1)
Status: (Passed) 2019-06-07 - Effective on 9/1/19 [HB1455 Detail]
Download: Texas-2019-HB1455-Enrolled.html
| H.B. No. 1455 | ||
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| 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 | ||
