Fair pharmacy audit legislation passes Ohio Senate unanimously!
We’re pleased to report that SB 258, the fair pharmacy audit bill sponsored by Sen. Troy Balderson, has passed out of the Senate Insurance & Financial Institutions Committee and went immediately to the Senate floor where it passed 30-0! The bill aims to establish standards for the performance of pharmacy audits by pharmacy benefit managers (PBMs), which are totally unregulated in the state of Ohio at this time. SB 258 would make PBMs subject to reasonable audit standards by placing guidelines on when and how audits are conducted. These standards include:
- providing the pharmacy at least 10 days’ notice of their intent to audit;
- allowing recoupment only if the errors are substantive and not merely typographical or clerical in nature;
- limiting the practice of extrapolation under most conditions;
- establishing a written appeals process that clearly defines timelines for appealing audit findings;
- resubmitting a disputed claim using commercially reasonable methods; and
- requiring that an audit go back no further than two years from when prescription was filled.
Here’s a link to the text of the bill along with a list of co-sponsors: http://www.legislature.state.oh.us/bills.cfm?ID=130_SB_258
Senator Balderson’s sponsor testimony was followed by proponent testimony the National Community Pharmacists Association; John Coler, owner of Shrivers Pharmacies, Zanesville; Rick Carano, owner of Village Apothecary, Youngstown area; Jerry Ritzman, Vice President of Pharmacy Services, Ritzman Pharmacies; Steve Ferris, Government Affairs Director, Discount Drug Mart; Tim Weber, Vice President, Fruth Pharmacy; and Pharmacy Audit Assistance Services (PAAS). Each highlighted some of the wasteful and unnecessary audits that are occurring on a regular basis in community pharmacies across the state.
Here is a press release from the Senate announcing passage of the bill: http://www.ohiosenate.gov/republicans/press/senate-clears-balderson-initiative-to-support-local-pharmacies
We ask that you please take a moment to thank your senator for their support for SB 258. You can locate your senator here: http://www.ohiosenate.gov
Now it’s onto the House! If you have experienced a wasteful, unnecessary audit, please let your representative know: http://www.ohiohouse.gov/
Also, as a sidenote, I ask that if you have not already acted on our VoterVoice Action alert on HB 394, our immunization expansion bill, please do so this week, as it may be up for a floor vote next week. Here’s a link to our action alert: https://www.votervoice.net/OPA/campaigns/35054/respond OR if you’d link to call your legislator directly, you can look them up here: http://www.ohiohouse.gov/ Let Antonio Ciaccia know at email@example.com which rep you end up contacting so we can keep track of who has/hasn’t been contacted. The pediatricians are fighting back, and we need your help to get the votes. Thanks.
Please consider financial support of our legislative efforts by contributing to the OPA Pharmacy PAC. 100% of Pharmacy PAC money contributed by pharmacists goes to help candidates who support pharmacy in Ohio.
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