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House approves standards for pharmacy audits aimed at PBMs, exempts federal programs
Summary
The House passed a second-substitute to HB76 establishing best-practice standards for pharmacy audits by pharmacy benefit managers (PBMs), excluding Medicare and Medicaid, and setting notice and appeal parameters; sponsor said cases of probable fraud remain outside the bill's auditing protections.
The Utah House approved a second-substitute to House Bill 76 on Feb. 24 that sets up best-practice standards for audits conducted by pharmacy benefit managers (PBMs) of pharmacies and clarifies that federally funded programs are excluded.
Representative Vickers, sponsor of the motion to uncircle and present the bill, told colleagues the language defines fraud using federal terms, sets parameters for notification and the scope of audits, and outlines an appeal process. The proposal was developed with PBMs and pharmacy stakeholders and, according to the sponsor, follows models used by about 30 other states.
Vickers stressed that the bill excludes Medicaid and Medicare from its provisions because those programs already have their own audit frameworks. He also said the bill contains carve-outs for situations where probable fraud is suspected, in which case the bill’s more protective audit procedures would not apply.
The House voted to uncircle and pass the second substitute for HB76; the measure received 69 yes votes and 1 no vote and will be transmitted to the Senate for consideration.
