86R24904 LED-F
 
  By: Hunter, Raney, Zedler, et al. H.B. No. 1455
 
  Substitute the following for H.B. No. 1455:
 
  By:  Lucio III C.S.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 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.