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NACDS, NCPA hail Utah bill on PBM audits
March 14th, 2012
ALEXANDRIA, Va. – The National Association of Chain Drug Stores and the National Community Pharmacists Association praised the Utah state legislature for passing a bill that would require audits conducted by pharmacy benefit managers (PBMs) to be fair and rational.
NACDS said Wednesday that Utah's Pharmacy Audit Integrity and Recovery Act (H.B. 76), sponsored by State Rep. Evan Vickers (R.), would mandate audits involving clinical or professional judgment to be conducted by or in consultation with a pharmacist, and with 10 days advanced written notice.
In addition, the bill also limits the number of selected prescription claims to 200 and doesn't allow for the recoupment of funds for clerical errors, according to NACDS.
"The passage of this legislation is an important step in curbing questionable tactics used by PBMs that only seek to hurt patients and increase already skyrocketing health care costs," NACDS president and chief executive officer Steve Anderson said in a statement. "The lack of transparency by PBMs in the audit process has penalized community pharmacy and, more importantly, posed challenges to patients, including increased drug costs.
"We thank Rep. Vickers for his leadership in passing this bill, as well as the efforts of the Utah Retail Merchants Association and the Utah Food Industry Association in achieving this legislative victory," he added.
A 2011 NCPA survey of 1,850 community pharmacists conducted by shows the need for the reforms in H.B. 76, the association noted. Sixty-two percent of pharmacists polled considered the audit requirements to be completely inconsistent from one health plan to another; 48% reported auditors asking them to justify claims that are 2 years old or older; and, of the pharmacists who report having appealed a PBM audit, 81% described that process as burdensome and unsatisfactory. Also, when asked how PBM reimbursement and auditing practices affect pharmacists' ability to provide patient care and remain in business, 97% of pharmacists said it was a significant or very significant factor.
"This legislation is an important step forward for patients and pharmacists across Utah," stated NCPA CEO B. Douglas Hoey. "Fair auditing of pharmacies is a legitimate way to protect public and private health plans from waste, fraud and abuse. However, recently pharmacy auditing practices are sapping pharmacists' time to counsel patients and appear to be more about generating revenue for the middleman than rooting out fraud. There's no reason for community pharmacists to routinely lose time and thousands of dollars in audits when the right medication is dispensed to the right patient at the right time.
"We commend state representative, pharmacist and NCPA member Evan Vickers, the Independent Pharmacy Cooperative and the Utah Pharmacists Association for making it happen," Hoey added. "NCPA was proud to support their grassroots efforts."
The bill is now headed to Utah Gov. Gary Herbert for signature.
“We urge Gov. Herbert to follow the lead of the Senate and House and sign this important pro-patient, pro-pharmacy bill into law," commented Anderson.