Pharmacy industry applauds Senate passage of audit reforms

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A group of consumers, local businesses and pharmacists met at the Florida Capitol  to highlight pending legislation establishing “clear guidelines” on pharmacy audits.

Pharmacy Choice and Access Now (PCAN), joined by legislators and industry representatives, held a press conference today to praise the Senate Health Policy Committee and Senate Regulated Industries Committee for approving SB 702 and encouraging the House to pass companion bill HB 745.

Sen. Aaron Bean and Rep. Travis Cummings, sponsors of the bills making process through the Legislature, were on hand at the Florida Senate chamber to highlight the importance of appropriate standards for pharmacy audits they believe will treat pharmacists fairly and put consumers first.

The bills address a problem that has been steadily affecting the more than 2,700 pharmacies all across Florida. Pharmacy Benefit Managers routinely evaluate pharmacies to make certain claims are submitted and handled properly.

According to PCAN, those audits have become increasingly time-consuming, taking pharmacists away from patients.

“Pharmacies employ tens of thousands of Floridians and bring hundreds of millions in revenue to our state,” Bean said. “SB 702 establishes predictable and fair auditing practices to help pharmacists focus on the health and wellness of their patients.”

SB 702 and HB 745 are an attempt to make “common-sense auditing standards” that include:

  • One week advance notice before conducting an audit
  • Audits requiring clinical or professional judgment be conducted by or in consultation with a pharmacist
  • No penalties or financial recoupment for basic clerical, typographical, or computer errors if the script was properly and accurately dispensed unless there is a pattern of such errors, fraudulent billing is alleged or errors result in financial loss
  • Prohibits using extrapolations in auditing claims
  • Allowing 10 days for pharmacists to provide documentation to address any discrepancies found during an audit
  • Delivery of initial audit reports to pharmacists within 120 days after an audit is completed
  • The Office of Insurance Regulation will study pharmacy complaints of willful violations of audit provisions by PBMs
  • Limits auditing period to two calendar years after the prescription is submitted or adjudicated

In a recent survey of Florida community pharmacists, nearly half had dispensing records older than two years audited, and 90 percent were penalized for non-fraudulent clerical errors.

In addition, almost 95 percent of pharmacists  also said they felt powerless to negotiate terms of contracts with PBMs.

This purpose of the legislation is to streamline the auditing process; ensuring pharmacists spend more time with patients instead of paperwork.

“Pharmacists work constantly to make certain they are in compliance in order to ensure the safety and security of the patients they serve,” said PCAN National Board Chair Bill Mincy. “These audits are increasingly unpredictable and have become an unfair practice by PBMs in Florida.” 

Florida pharmacies bring in over $350 million in tax revenue, and employ over 32,000 people with an estimated payroll over $1.1 billion. As the primary source of prescription medications, pharmacists are the medication experts most Floridians rely on.

Peter Schorsch is the President of Extensive Enterprises and is the publisher of some of Florida’s most influential new media websites, including SaintPetersBlog.com, FloridaPolitics.com, ContextFlorida.com, and Sunburn, the morning read of what’s hot in Florida politics. SaintPetersBlog has for three years running been ranked by the Washington Post as the best state-based blog in Florida. In addition to his publishing efforts, Peter is a political consultant to several of the state’s largest governmental affairs and public relations firms. Peter lives in St. Petersburg with his wife, Michelle, and their daughter, Ella.