As of February 23, 2023, The New York Department of Financial Services’ Pharmacy Benefits Bureau is looking to enact the Pharmacy Benefit Manager Laws, thus announcing a final request for public engagement. In an attempt to lessen the fraud, waste, and abuse within health care services, pharmacies retained information from PBM audits to avoid “predatory and unfair practices”.
The information retained from the resulting audits look to highlight the widening developments by the Department, making rules to address “deceptive practices”, “anti-competitive practices”, and “standards and practices used in the creation of pharmacy networks and contracting with network pharmacies and other providers…”
Superintendent Harris emphasizes the importance of participating with stakeholders through facts and market data-based policy decisions. With that in mind, interested parties should expect to answer the following questions, in response to the PBMs pharmacy audit conductions:
For pharmacies:
– How does an auditing PBM express its policies and methods to your pharmacy, and in what forms of communication?
– Have you experienced any audits in the past five years? If so, in what forms were the audits administered (onsite audits, desktop audits, etc.)?
– In the past five years, how many times have you experienced PBM audits for your pharmacy business?
– What methods have you used in attempting to contact the auditing PBM about their audit findings, or conduct?
– Have you ever felt uncertain about why certain documentation was not accepted by the auditing PBM?
– How have audit findings impacted your pharmacy’s networking?
– Has your office staffing been impacted by audits in your pharmacy?
For PBMs:
– What is the main purpose for pharmacy audits?
– How are payments and savings disbursed with the plans you distribute benefits for?
– What do fraud and misrepresentation get internally defined as for audits to be administered?
Any interested parties are welcome to provide feedback on the Request for Public Comments as the PBB is always available to investigate complaints of PBM misconduct. Please email [email protected] for more information.
Any consumer that has received a drastic increase in their cost of drugs, please reach out to the Department of Financial Services at [email protected].
The Office of Sinayskaya Yuniver will continue to update as we learn further information.