Bill Text: TX HB1455 | 2019-2020 | 86th Legislature | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft
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-Introduced.html
  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.
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