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Governor Signs Bill Providing Wholesale Audit Protections

Friday, June 7, 2019   (0 Comments)
Posted by: Brian Sparks
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Protection from Wholesale Invoice Audits

On June 7, Governor Greg Abbott signed House Bill 1455 to provide pharmacy protection from wholesale invoice audits.

The legislation prohibits pharmacy benefit managers (PBMs) that audit wholesale invoices from auditing claims that a pharmacy has from another PBM or health plan. PBMs are prohibited from finding an audit discrepancy if the National Drug Code (NDC) 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, the pharmacist or pharmacy dispensed the correct quantity of the drug according to the prescription, and the drug dispensed by the pharmacist or pharmacy shares all but the last two digits of the NDC of the drug reflected on the supplier invoice. Additionally, PBMs are required to accept the copies of supplier invoices possessed by the audited pharmacy as evidence to support the validity of a claim, subject to the validation by pharmacy purchase order and payment of supplier invoice.

This means that community pharmacies in Texas are now protected from overreach by PBM practices in wholesale invoice audits that attempt to unnecessarily penalize businesses for legitimate claims based on administrative technicalities. Pharmacies may now avoid said penalties that could be a financial burden.

Thanks to Rep. Todd Hunter and Sen. Dawn Buckingham for supporting this pharmacy priority!


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