AB114-ASA1,14,1813
6. Allow the pharmacist or pharmacy to use authentic and verifiable records
14of a hospital, physician, or other health care provider to validate the pharmacist's or
15pharmacy's records relating to delivery of a prescription drug and use any valid
16prescription that complies with requirements of the pharmacy examining board to
17validate claims in connection with a prescription, refill of a prescription, or change
18in prescription.
AB114-ASA1,14,2119
7. Allow the pharmacy or pharmacist to document the delivery of a prescription
20drug or pharmacist services to an enrollee under a health benefit plan using either
21paper or electronic signature logs.
AB114-ASA1,14,2422
8. Before leaving the pharmacy after concluding the on-site portion of an audit,
23provide to the representative of the pharmacy or the pharmacist a complete list of
24the pharmacy records reviewed.
AB114-ASA1,15,2
1(c)
Results of audit. An entity that has conducted an audit of a pharmacist or
2pharmacy shall do all of the following:
AB114-ASA1,15,103
1. Deliver to the pharmacist or pharmacy a preliminary report of the audit
4within 60 days after the date the auditor departs from an on-site audit or the
5pharmacy or pharmacist submits paperwork for a desk audit. A preliminary report
6under this subdivision shall include claim-level information for any discrepancy
7reported, the estimated total amount of claims subject to recovery, and contact
8information for the entity or person that completed the audit so the pharmacist or
9pharmacy subject to the audit may review audit results, procedures, and
10discrepancies.
AB114-ASA1,15,1311
2. Allow a pharmacist or pharmacy that is the subject of an audit to provide
12documentation to address any discrepancy found in the audit within 30 days after
13the date the pharmacist or pharmacy receives the preliminary report.
AB114-ASA1,15,1914
3. Deliver to the pharmacist or pharmacy a final audit report, which may be
15delivered electronically, within 90 days of the date the pharmacist or pharmacy
16receives the preliminary report or the date of the final appeal of the audit, whichever
17is later. The final audit report under this subdivision shall include any response
18provided to the auditor by the pharmacy or pharmacist and consider and address the
19pharmacy's or pharmacist's response.
AB114-ASA1,15,2220
4. Refrain from assessing a recoupment or other penalty on a pharmacist or
21pharmacy until the appeal process is exhausted and the final report under subd. 3.
22is delivered to the pharmacist or pharmacy.
AB114-ASA1,15,2423
5. Refrain from accruing or charging interest between the time the notice of the
24audit is given under par. (b) 1. and the final report under subd. 3. has been delivered.
AB114-ASA1,15,2525
6. Exclude dispensing fees from calculations of overpayments.
AB114-ASA1,16,4
17. Establish and follow a written appeals process that allows a pharmacy or
2pharmacist to appeal the final report of an audit and allow the pharmacy or
3pharmacist as part of the appeal process to arrange for, at the cost of the pharmacy
4or pharmacist, an independent audit.
AB114-ASA1,16,85
8. Refrain from subjecting the pharmacy or pharmacist to a recoupment or
6recovery for a clerical or record-keeping error in a required document or record,
7including a typographical or computer error, unless the error resulted in an
8overpayment to the pharmacy or pharmacist.
AB114-ASA1,16,149
(d)
Confidentiality of audit. Information obtained in an audit under this
10subsection is confidential and may not be shared unless the information is required
11to be shared under state or federal law and except that the audit may be shared with
12the entity on whose behalf the audit is performed. An entity conducting an audit may
13have access to the previous audit reports on a particular pharmacy only if the audit
14is conducted by the same entity.
AB114-ASA1,16,1815
(e)
Cooperation with audit. If an entity is conducting an audit that is complying
16with this subsection in auditing a pharmacy or pharmacist, the pharmacy or
17pharmacist that is the subject of the audit may not interfere or refuse to participate
18in the audit.
AB114-ASA1,16,2119
(f)
Payment of auditors. A pharmacy benefit manager or entity conducting an
20audit may not pay an auditor employed by or contracted with the pharmacy benefit
21manager or entity based on a percentage of the amount recovered in an audit.
AB114-ASA1,16,2422
(g)
Applicability. 1. This subsection does not apply to an investigative audit
23that is initiated as a result of a credible allegation of fraud or willful
24misrepresentation or criminal wrongdoing.
AB114-ASA1,17,3
12. If an entity conducts an audit to which a federal law applies that is in conflict
2with all or part of this subsection, the entity shall comply with this subsection only
3to the extent that it does not conflict with federal law.
AB114-ASA1,17,11
4(7) Transparency reports. (a) Beginning on June 1, 2021, and annually
5thereafter, every pharmacy benefit manager shall submit to the commissioner a
6report that contains, from the previous calendar year, the aggregate rebate amount
7that the pharmacy benefit manager received from all pharmaceutical manufacturers
8but retained and did not pass through to health benefit plan sponsors and the
9percentage of the aggregate rebate amount that is retained rebates. Information
10required under this paragraph is limited to contracts held with pharmacies located
11in this state.
AB114-ASA1,17,1312
(b) Reports under this subsection shall be considered a trade secret under the
13uniform trade secret act under s. 134.90.
AB114-ASA1,17,1514
(c) The commissioner may not expand upon the reporting requirement under
15this subsection, except that the commissioner may effectuate this subsection.
AB114-ASA1,22
16Section 22
. Chapter 633 (title) of the statutes is amended to read:
AB114-ASA1,17,2017
CHAPTER 633
18
EMPLOYEE BENEFIT PLAN
19
ADMINISTRATORS
AND, PRINCIPALS
,
20
and Pharmacy benefit managers
AB114-ASA1,23
21Section
23. 633.01 (1) (intro.) and (c) of the statutes are amended to read:
AB114-ASA1,17,2522
633.01
(1) (intro.) “Administrator" means a person who directly or indirectly
23solicits or collects premiums or charges or otherwise effects coverage or adjusts or
24settles claims for
a an employee benefit plan, but does not include the following
25persons if they perform these acts under the circumstances specified for each:
AB114-ASA1,18,3
1(c) A creditor on behalf of its debtor, if to obtain payment, reimbursement or
2other method of satisfaction from
a an employee benefit plan for any part of a debt
3owed to the creditor by the debtor.
AB114-ASA1,24
4Section
24. 633.01 (2r) of the statutes is created to read:
AB114-ASA1,18,55
633.01
(2r) “Enrollee” has the meaning given in s. 632.861 (1) (b).
AB114-ASA1,25
6Section
25. 633.01 (3) of the statutes is amended to read:
AB114-ASA1,18,87
633.01
(3) “Insured
employee" means an employee who is a resident of this
8state and who is covered under
a an employee benefit plan.