A bill that would add uniformity and consistency to auditing practices by private insurance companies finally received its first committee hearing Tuesday afternoon, winning the support of each member of the Florida Senate Health Policy Committee.
Health insurance companies routinely audit pharmacies through third-party pharmacy benefit managers (PBMs), who may or may not be licensed pharmacists. SB 1358 (Audits of Pharmacy Records), sponsored by Sen. Anitere Flores, R-Miami, would:
-- require one week prior notice before conducting an audit;
-- require the audit to be conducted by a Florida-licensed pharmacist;
-- prohibit penalties for clerical errors in pharmacy record keeping without proof of intent to commit fraud;
-- allow 10 days for pharmacists to produce documentation to address any discrepancies found during the audit;
-- deliver audit reports to pharmacists within 90 days after an audit is completed;
-- establish an appointed peer-review panel of unfavorable audit reports; and
-- limit an auditing period to one calendar year.
Flores told panelists these same measures have been adopted by Medicare and Medicaid, saying [i]t's worked very well; we should have that same process for these smaller, privately owned pharmacies as well.
Chairman Aaron Bean, R-Jacksonville, agreed.
Originally, I wasn't sold on this bill, because it [interferes with] a private contract between pharmacists and pharmacy benefit managers, he told committee members, introducing Flores' bill. However, after listening to pharmacists, I believe if we don't do something to protect our local independent pharmacists, [consumers] will have limited choices.
Senators heard testimony from pharmacists who complained that they had been fined thousands of dollars for what amounted to clerical errors --e.g., accepting prescriptions from doctors who wrote the date using numerals instead of spelling out the name of the month.
Bean and Flores promised to continue to work with auditers and insurance companies to modify the bill to meet some of their concerns that it does not go far enough to protect against fraud.
"The committee was deliberative and came to the right conclusion --fair audits are good, and unfair, overburdensome audits are bad for small-business owners, Kevin Cate, spokesman for the Pharmacy Choice and Access Now coalition, told Sunshine State News after senators approved SB 1358. We now implore the Senate and House of Representatives to protect local pharmacies by quickly moving this legislation.
House companion HB 791, sponsored by Rep. Manny Diaz, R-Hialeah, died in the House two weeks ago, though it could be revived through any number of procedural maneuvers if Flores' bill makes its way to the Senate floor and passes.
Reach Eric Giunta at egiunta@sunshinestatenews.com or at (954) 235-9116.
