Governor Wolf has signed a bill standardizing pharmacy audit procedures, requiring pharmacy benefit managers (PBMs) to register with the Pennsylvania Department of Insurance, and placing transparency requirements on PBMs. HB 946, sponsored by Rep. Matt Baker (R-Tioga), is now Act 169. The registration requirement takes effect in 90 days, while the rest takes effect in 180 days.
Specifically, Act 169 contains the following requirements:
• Seals audit reports to everyone apart from the PBM and insurer.
• Prohibits auditors from compensating based on amounts recouped.
• Requires auditors to provide pharmacies 14 days notice before conducting the audit.
• Prohibits audits in the first five business days of the month for any pharmacy filling 600 prescriptions per week.
• Requires both paper and electronic signature logs be accepted.
• Requires the auditor provide the pharmacy a list of reviewed records.
• Requires a pharmacist to be involved in any decisions requiring clinical judgement.
• Prohibits audits reviewing records more than two years old or involving more than 250 prescriptions.
• Prohibits auditors from extrapolating to calculate penalties.
• Prohibits auditors from collecting dispensing fees in overpayments, unless in the case of a misfill.
• Requires the auditor to provide a comprehensive report to the pharmacy within 60 days, and gives the pharmacy 30 days to respond.
This bill was considered at length by the Governor, when resistance emerged from the governmental departments concerned about the cost and efficacy of oversight. PFMA supported this bill and sent letters encouraging the Governor to sign it, which he did on November 21.
Specifically, Act 169 contains the following requirements:
• Seals audit reports to everyone apart from the PBM and insurer.
• Prohibits auditors from compensating based on amounts recouped.
• Requires auditors to provide pharmacies 14 days notice before conducting the audit.
• Prohibits audits in the first five business days of the month for any pharmacy filling 600 prescriptions per week.
• Requires both paper and electronic signature logs be accepted.
• Requires the auditor provide the pharmacy a list of reviewed records.
• Requires a pharmacist to be involved in any decisions requiring clinical judgement.
• Prohibits audits reviewing records more than two years old or involving more than 250 prescriptions.
• Prohibits auditors from extrapolating to calculate penalties.
• Prohibits auditors from collecting dispensing fees in overpayments, unless in the case of a misfill.
• Requires the auditor to provide a comprehensive report to the pharmacy within 60 days, and gives the pharmacy 30 days to respond.
This bill was considered at length by the Governor, when resistance emerged from the governmental departments concerned about the cost and efficacy of oversight. PFMA supported this bill and sent letters encouraging the Governor to sign it, which he did on November 21.
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