Utah passes Pharmacy Audit Integrity and Recovery Act

ALEXANDRIA, Va. — Legislation designed to reform the pharmacy audit process has been approved in Utah and will be sent to the state governor to sign.

In a 73-1 vote, H.B. 76, known as the Pharmacy Audit Integrity and Recovery Act, "requires health benefit plans, the Public Employees' Benefits and Insurance Program and pharmacy benefit managers to implement certain pharmacy audit procedures when auditing pharmacy claims," according to the legislation document. Key provisions included:

  • Clerical or recordkeeping error, such as a typo, should not be considered fraud or subject to recoupment or criminal penalties;

  • Findings of overpayment or underpayment must be based on actual overpayment or underpayment and not a projection;

  • Audits cannot recoup dispensing fees from the pharmacy;

  • An auditing entity may not be paid based on a percentage of the amount recovered;

  • All pharmacies are to be audited under the same standards or parameters as other pharmacies;

  • The period covered by the audit may not exceed 18 months, unless superseded by federal law; and

  • Audits have a 200 script maximum limit.

The bill's chief sponsor was Rep. Evan Vickers (R-Utah), who is a pharmacist and a member of the National Community Pharmacists Association.

"This legislation is an important step forward for patients and pharmacists across Utah," NCPA CEO Douglas Hoey said. "Fair auditing of pharmacies is a legitimate way to protect public and private health plans from waste, fraud and abuse. However, recently pharmacy auditing practices are sapping pharmacists' time to counsel patients and appear to be more about generating revenue for the middleman than rooting out fraud. There's no reason for community pharmacists to routinely lose time and thousands of dollars in audits when the right medication is dispensed to the right patient at the right time. We commend state representative, pharmacist and NCPA member Evan Vickers, the Independent Pharmacy Cooperative and the Utah Pharmacists Association for making it happen. NCPA was proud to support their grassroots efforts."

The passage of the Pharmacy Audit Integrity and Recovery Act also was praised by the National Association of Chain Drug Stores.

"The passage of this legislation is an important step in curbing questionable tactics used by PBMs that only seek to hurt patients and increase already-skyrocketing healthcare costs," NACDS president and CEO Steve Anderson said. "The lack of transparency by PBMs in the audit process has penalized community pharmacy and more importantly, posed challenges to patients including increased drug costs. We thank Rep. Vickers for his leadership in passing this bill, as well as the efforts of the Utah Retail Merchants Association and the Utah Food Industry Association in achieving this legislative victory."


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