By: Hunter, et al.	H.B. No. 1455
	(Senate Sponsor - Buckingham, Schwertner)
	(In the Senate - Received from the House April 25, 2019;
	April 29, 2019, read first time and referred to Committee on
	Business & Commerce; May 15, 2019, reported favorably by the
	following vote:  Yeas 7, Nays 0; May 15, 2019, sent to printer.)
Click here to see the committee vote

	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 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.
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