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Who cares
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Sponsors
No co-sponsors yet.
History
- Referred to health
- Delivered to assembly
- Passed senateVote 62–0
- Ordered to third reading cal.1781
- Committee discharged and committed to rules
- Referred to health
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
Title of bill
An act to amend the public health law, in relation to audits of pharmacies
Purpose
To establish statutory guidelines regarding the audit of pharmacy records conducted on the behest of or ordered by a pharmacy benefit manager, and to provide guidance to a pharmacy benefit manager regarding the denial or payment of claims.
Summary of provisions
Section one adds a new section 280-b in the public health bill and would require a public benefit manager that looks to audit pharmacy records to:
Not conduct an on-site audit of a pharmacy during the first three calendar days of any month.
Notify the pharmacy that an audit is pending at least seven days before the audit begins.
Limit audit periods to 24 months after the date a claim is submitted. Require the acceptance of written and verifiable records to validate pharmacy records.
Provide the affected pharmacy with a copy of a preliminary audit report within 120 days of the audit completion.
Provide the pharmacy a way to provide documentation to contest audit findings.
Provide the pharmacy with the final audit report within six months of the initial report receipt.
The bill also would require a pharmacy benefit manager to pay a claim submitted by a pharmacy if the initial reason for denial is tied to clerical or other non-intentional error if the relevant prescription was still effectively filled.
The audit requirements would not apply to an audit initiated on the reasonable suspicion of deliberate fraud, or audits of claims paid by federal programs such as Medicaid or Medicare, or timely routine desk audits where no chargeback or recoupment are demanded.
Section 3: Effective date.
Justification
The bill is designed to limit purported or suspected uses of audit procedures or payment denials by pharmacy benefit managers to inhibit normal business activities of pharmacies of whatever size and nature, and to provide a more level competitive playing field for all pharmaceutical providers.
Legislative history
This is a new bill.
Fiscal implications
None to the State EFFECTIVE DATE : Sixty days after enactment.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.