Second Regular Session S.B. 1165
PROPOSED
SENATE AMENDMENTS TO S.B. 1165
(Reference to printed bill)
Page 1, line 4, after "prohibition" insert "; claim payment reduction"
Line 30, strike the colon
Line 31, strike "(i)"
Line 32, strike the period insert "and either of the following applies:"
Renumber to conform
Line 45, after the comma insert "subject to validation that includes validating the pharmacy purchase order and the PAYMENT of the supplier invoice, and"
Page 2, line 6, strike "fifth" insert "tenth"
Strike lines 28 through 41, insert:
"D. An auditing entity may not, directly or indirectly, retroactively reduce the amount of a claim payment to a pharmacist or a pharmacy after adjudication of the claim for a prescription drug unless any of the following applies:
1. The original claim was found to have been fraudulently submitted through an audit conducted in accordance with this article.
2. The claim submitted was a duplicate for which the pharmacy had already received payment.
3. The original reimbursement was incorrect due to an unintentional error that resulted in an overpayment by an insurer or a pharmacy benefit manager.
E. Subsection D of this section does not prohibit an auditing entity, insurer or pharmacy benefit manager from increasing the amount of a claim payment after adjudication of the claim."
Amend title to conform