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A BILL TO BE ENTITLED
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AN ACT
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relating to the audit of wholesale invoices during certain audits |
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of pharmacists and pharmacies. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter F, Chapter 1369, Insurance Code, is |
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amended by adding Section 1369.2581 to read as follows: |
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Sec. 1369.2581. AUDIT DISCREPANCIES; WHOLESALE INVOICES. |
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(a) A health benefit plan issuer or pharmacy benefit manager that |
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audits wholesale invoices during an audit of a pharmacist or |
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pharmacy may not audit the pharmacy claims of another health |
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benefit plan or pharmacy benefit manager. |
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(b) A health benefit plan issuer or pharmacy benefit manager |
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shall reverse a finding of a discrepancy if: |
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(1) the National Drug Code for the dispensed drug is in |
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a quantity that is a subunit or multiple of the drug purchased by |
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the pharmacist or pharmacy as supported by a wholesale invoice; |
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(2) the pharmacist or pharmacy dispensed the correct |
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quantity of the drug; and |
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(3) the dispensed drug is identical in strength and |
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dosage to the drug purchased by the pharmacist or pharmacy from the |
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wholesaler. |
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(c) A health benefit plan issuer or pharmacy benefit manager |
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must accept as evidence to support the validity of a pharmacy claim |
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related to a dispensed drug: |
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(1) copies of supplier invoices in the pharmacist's or |
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pharmacy's possession, including: |
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(A) supplier invoices issued before the date the |
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drug was dispensed; and |
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(B) invoices from any supplier authorized to |
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transfer ownership of the drug acquired by the pharmacist or |
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pharmacy; and |
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(2) reports required by any state board or agency. |
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(d) A health benefit plan issuer or pharmacy benefit manager |
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must provide, not later than the fifth business day after a request |
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by the pharmacist or pharmacy, any supporting documents the |
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pharmacist's or pharmacy's suppliers provided to the health benefit |
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plan issuer or pharmacy benefit manager. |
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(e) A health benefit plan issuer or pharmacy benefit manager |
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may not recoup any amount based on a wholesale invoice discrepancy |
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regarding the patient's receipt of a dispensed drug if the audited |
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pharmacy claim is supported by records of the pharmacist or |
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pharmacy showing that the patient or patient's agent received the |
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dispensed drug underlying the audited pharmacy claim. |
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SECTION 2. The changes in law made by this Act apply only to |
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an audit conducted under a contract between a pharmacist or |
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pharmacy and a health benefit plan issuer or pharmacy benefit |
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manager entered into, amended, or renewed on or after the effective |
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date of this Act. |
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SECTION 3. This Act takes effect September 1, 2019. |