Bill Text: TX SB692 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to the audit of wholesale invoices during certain audits of pharmacists and pharmacies.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2019-03-01 - Referred to Business & Commerce [SB692 Detail]
Download: Texas-2019-SB692-Introduced.html
| 86R888 LED-F | ||
| By: Buckingham | S.B. No. 692 | |
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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; 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. | ||
