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ALEXANDRIA, Va. — The National Community Pharmacists Association is calling on lawmakers in Pennsylvania to pass legislation to establish fair standards for pharmacy audits by pharmacy benefit managers (PBMs).
NCPA said this week that it has sent a letter to Pennsylvania state leaders urging them to support H.B. 727, which the association wrote is "needed to provide community pharmacy with fair and commonsense protections against abusive PBM pharmacy auditing practices."
"This important legislation is based on a simple principle: When a pharmacist dispenses the right medication to the right patient at the right time, as prescribed by a doctor, it should not be a punishable offense," NCPA chief executive officer B. Douglas Hoey said in a statement.
With the letter, NCPA included examples of abusive auditing experiences from some of the 1,000 independent pharmacies in Pennsylvania. In one case, NCPA said, a health plan sought to recoup $250,000 from a pharmacy when the pharmacist filing a claim for reimbursement used what was a valid physician’s prescriber number for that particular doctor, but not the prescriber number preferred by the plan. "A quarter of a million dollars when no ill intent was intended and no error was even made, harm done to any consumer, or money lost by any party involved," the pharmacist stated.
NCPA noted that more than 20 states have enacted pharmacy audit bills into law, and 10 of those states — Alabama, Indiana, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, South Carolina, Utah and Vermont — have enacted or bolstered such laws in just the past five months. In California, such a measure recently passed both chambers of the state legislature.
"Pharmacists recognize the need for legitimate audits to protect public and private health plans from waste, fraud and abuse. However, pharmacy auditing practices are out of control," Hoey explained. "Time-consuming, abusive audits compromise pharmacists’ availability to counsel patients. Increasingly, they appear to be more about generating revenue for the middleman than rooting out fraud."
