Bill Text: IN HB1051 | 2012 | Regular Session | Introduced
Bill Title: Pharmacy audits.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2012-01-26 - Representative Welch added as coauthor [HB1051 Detail]
Download: Indiana-2012-HB1051-Introduced.html
Citations Affected: IC 25-26-22.
Synopsis: Pharmacy audits. Specifies pharmacy audit requirements,
including limitations on an initial audit and on onsite audits. Requires
a period of at least 60 days during which a pharmacy may appeal
preliminary audit report findings. Prohibits the recoupment of
dispensing fees under certain circumstances. Requires reimbursement
of a pharmacy for the copying of prescriptions and provides for the
correction of prescription errors.
Effective: July 1, 2012.
January 4, 2012, read first time and referred to Committee on Public Health.
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(1) The contract under which the audit is performed must provide a description of audit procedures that will be followed.
(2) For an onsite audit conducted at a pharmacy's location, the auditor that conducts the audit shall provide written notice to the pharmacy at least two (2) weeks before the initial onsite audit is performed for each audit cycle.
(3) The auditor shall not interfere with the delivery of pharmacist services to a patient and shall use every effort to minimize
inconvenience and disruption to pharmacy operations during the
audit. This subdivision does not prohibit audits during normal
business hours of the pharmacy.
(4) If the audit requires use of clinical or professional judgment,
the audit must be conducted by or in consultation with a licensed
pharmacist.
(5) The auditor shall allow the use of written or otherwise
transmitted hospital, physician, or other health practitioner
records to validate a pharmacy record with respect to a
prescription for a legend drug.
(6) The auditor shall perform the audit according to the same
standards and parameters that the auditor uses to audit all other
similarly situated pharmacies on behalf of the third party payer.
(7) The period covered by the audit must not exceed twenty-four
(24) eighteen (18) months after the date on which the claim that
is the subject of the audit was submitted to or adjudicated by the
third party payer, and the pharmacy must be permitted to resubmit
electronically any claims disputed by the audit. This subdivision
does not limit the period for audits under the Medicaid program
that are conducted due to a federal requirement.
(8) The audit must not be initiated or scheduled during the first
five (5) seven (7) calendar days of any month without the
voluntary consent of the pharmacy. The consent may not be
mandated by a contract or any other means.
(9) Payment to the onsite auditor for conducting the audit must
not be based on a percentage of any amount recovered as a result
of the audit.
(10) A pharmacy may reschedule an audit to a date not more
than fourteen (14) days after the date proposed by the
auditor.
(11) An initial audit must be limited to not more than
seventy-five (75) claims.
(12) The third party payer shall reimburse the pharmacy
twenty-five cents ($0.25) for each copy of a prescription
required for an audit.
(13) If a prescription error is identified by the auditor during
the course of an audit, the auditor shall allow the pharmacy
to obtain a corrected prescription from the prescribing
physician.
to the pharmacy written audit reports as follows:
(1) The auditor shall deliver a preliminary audit report to the
pharmacy not later than ninety (90) days after the audit is
concluded.
(2) The auditor shall provide with the preliminary audit report a
written appeal procedure for the pharmacy to follow if the
pharmacy desires to appeal a finding contained in the preliminary
audit report. The written appeal procedure must provide for a
period of at least sixty (60) days after the pharmacy receives
the preliminary audit report during which the pharmacy may
file an appeal of findings contained in the preliminary audit
report.
(3) The auditor shall deliver a final audit report to the pharmacy
not later than one hundred twenty (120) days after:
(A) the preliminary audit report is received by the pharmacy;
or
(B) if an appeal is filed, a final appeal determination is made;
whichever is later.
(4) Each audit report must be signed by the auditor and a
pharmacist participating in the audit.
(5) The auditor shall provide a copy of the final audit report to the
third party payer.
(b) An audit report provided to a pharmacy under this section
must be sent to the pharmacy by certified mail.
(1) a final audit report must be distributed; and
(2) at least thirty (30) days must elapse after the date on which the final audit report is distributed.
(b) Except for audits conducted under the Medicaid program, interest on funds described in subsection (a) does not accrue during the audit period.
(c) The recoupment of funds from a pharmacy based on an audit finding of overpayment of a claim may not include the recoupment of a dispensing fee if the pharmacy dispensed the drug or device prescribed in the prescription that is the subject of the claim.
