NCPA Endorses Pennsylvania Pharmacy Audit Reform Bill
The National Community Pharmacists Association issued this press release about the importance of protecting small businesses, like local pharmacies, from corporate abuse:
Pennsylvania state lawmakers should join the growing number of states passing legislation to set common-sense standards for pharmacy audits, the National Community Pharmacists Association (NCPA) said in a letter to Keystone State leaders. In its letter, NCPA calls on Pennsylvania state legislators to favorably move H.B.727.
“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,” said NCPA CEO B. Douglas Hoey, RPh, MBA. “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. 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.”
Accompanying NCPA’s letter was a sampling of abusive auditing experiences from some of the 1,000 independent community pharmacies in Pennsylvania. In one case, 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 lamented.
More than 20 states have enacted similar bills into law and 10 of those states – Alabama, Indiana, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, South Carolina, Utah and Vermont – have enacted or strengthened such laws in just the past five months. In California, such a measure recently passed both chambers of the state legislature.
As more states move Medicaid pharmacy services into a managed care system, we have been urging certain protections for pharmacies – including standards in auditing practices. We believe that all audits should be conducted using generally accepted auditing standards and in accordance with state and federal law, and that state laws should require MCOs to conduct fair audits of pharmacies, such as allowing pharmacies to appeal an audit’s findings. This protection is critical as it allows pharmacies to focus on serving patients.