STATEHOUSE - 

The Ohio Senate today passed Senate Bill 258, sponsored by Senator Troy Balderson (R–Zanesville), which establishes standards for the oversight of pharmacy audits in Ohio.
 
“My main objective in the Statehouse has been to create an environment in Ohio where businesses can grow and thrive so we can help our friends and neighbors get back to work,” said Balderson. “When our local pharmacies came and showed me the costly and burdensome process they have to undergo during audits, I knew we needed to do something to help these family-owned businesses.”
 
Ohio pharmacies are routinely audited by health plans and insurance companies to check for accuracy and to make certain there has been no fraud, waste, abuse, or clerical errors that may cause accidental overpayments. However, these audits frequently occur with little or no notice to the pharmacy and can be overly burdensome for local, independently owned pharmacies.
 
“This bill provides fair and uniform oversight for pharmacy audits and ensures this process pinpoints and weeds out actual fraud instead of simply creating unnecessary loopholes without improving the system for Ohioans or our local businesses,” added Balderson.
 
On average, the cost of per audit to a pharmacy is $2,500 and some Ohio pharmacies indicated that they face 6 of these audits each year.
 
Senate Bill 258 would make Pharmacy Benefit Managers (PBMs) subject to reasonable audit standards by placing guidelines on when and how audits are conducted. These new standards include:

  • Providing the pharmacy at least 10 days' notice of their intent to audit.
  • Allowing recoupment only if the errors are substantive and not merely typographical or clerical in nature.
  • Limiting the practice of extrapolation under most conditions.
  • Establishing a written appeals process that clearly defines timelines for appealing audit findings.
  • Resubmitting a disputed claim using commercially reasonable methods.

 
29 other states have already enacted audit reform measures similar to those in Senate Bill 258. The legislation now proceeds to the Ohio House of Representatives for further consideration.

 
 
 
  
Featured Posts

Jones Sets Priorities, Champions Accountability At First Meeting Of Commission On Infant Mortality

 

"There is a serious disconnect between the investments made and the people we are trying to impact," said Jones. "We need to look at the problem of infant mortality in a broader context, define the state's role in interacting with local communities on this issue and develop a system of accountability." 



 
 

LaRose Introduces Legislation To Improve Transparency In Local Elections

 

"The concept is pretty straightforward," said Senator LaRose. "This bill will update Ohio's campaign finance law to allow local entities to join a system that has operated smoothly for 15 years. There is no good reason to deny the public the opportunity to view local campaign finance reports online when state reports are already available."



 
 

Balderson Announces August District Office Hours In Pickaway County

 
COLUMBUS - 

“It is important that the people in the district have the opportunity to voice their concerns,” said Balderson. “My constituents are my number one priority and part of my responsibility as their elected official includes taking their views into account. Holding office hours in the district with either myself personally or my staff is a great way to offer constituents in-person meetings without having to travel to my office in Columbus."



 
 

Beagle, Lehner Reintroduce Legislation Aimed At Keeping Renters Safe

 
COLUMBUS - 

“When a fire breaks out, tenants have only moments to make a decision about how to safely escape. Every second counts and ensuring that an escape plan is in place is critical,” said Beagle.