This website will be unavailable from Friday, April 26, 2024 at 6:00 p.m. through Monday, April 29, 2024 at 7:00 a.m. due to data center maintenance.

                                                                                

79R6368 AJA-D

By:  Hupp                                                         H.B. No. 2148



A BILL TO BE ENTITLED

AN ACT

relating to audit practices of pharmacy benefit plans.                        
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter D, Chapter 4151, Insurance Code, as 
effective April 1, 2005, is amended by adding Section 4151.154 to 
read as follows:
	Sec. 4151.154.  AUDIT PRACTICES.  (a)  Audit practices used 
by a pharmacy benefit manager may consist only of methods and 
procedures that are recognized as equitable to the pharmacy benefit 
manager and the pharmacy audited.  The commissioner shall adopt 
rules as necessary to implement this subsection.
	(b)  A pharmacy benefit manager may not recover money owed by 
a pharmacy to the pharmacy benefit manager, as shown by an audit of 
the pharmacy, by reducing payments to the pharmacy from the 
pharmacy benefit manager before the audit results, including any 
challenges to the audit, are final and unappealable.
	(c)  A pharmacy benefit manager may not use extrapolation 
calculations in an audit of a pharmacy.
	SECTION 2.  The change in law made by this Act applies only 
to an audit performed by a pharmacy benefit manager on or after the 
effective date of this Act.  An audit performed by a pharmacy 
benefit manager before the effective date of this Act is governed by 
the law in effect immediately before that date, and that law is 
continued in effect for that purpose.
	SECTION 3.  This Act takes effect September 1, 2005.