Pharmacy audits; pharmacy benefits manager. (HB2561)

Introduced By

Del. Todd E. Pillion (R-Abingdon) with support from co-patron Del. Israel O'Quinn (R-Bristol)


Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law


Pharmacy audits; pharmacy benefits managers. Requires that provider contracts between a carrier or its pharmacy benefits manager and a pharmacy or its contracting agent provide that when an audit of the records of a pharmacy is conducted, the audit shall be conducted in accordance with specified criteria. Among other specifications, the criteria (i) require 30 days' advance notice before conducting the initial audit; (ii) bar audits during the first five calendar days of any month, on the day before or after a federal holiday, or on a Monday; (iii) give pharmacies the right to request a seven-day extension of the audit date; (iv) bar more than one audit of a pharmacy in a one-year period; (v) limit the period covered by an audit to two years from the date the initial prescription claim was submitted or adjudicated; (vi) require an audit that involves clinical or professional judgment to be conducted by or in consultation with a pharmacist; (vii) require audits to be conducted by a field agent who possesses the requisite expertise in pharmacy practice; and (viii) limit the circumstances in which reimbursements may be recouped. Read the Bill »


01/16/2019: Awaiting a Vote in the Health, Welfare and Institutions Committee


01/09/2019Prefiled and ordered printed; offered 01/09/19 19103158D
01/09/2019Referred to Committee on Health, Welfare and Institutions
01/16/2019Assigned HWI sub: Subcommittee #1

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