THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY GINGRICH, BAKER, BOBACK, BOYD, CALTAGIRONE, CLYMER, D. COSTA, ELLIS, FLECK, GRELL, GROVE, HENNESSEY, HESS, KAUFFMAN, M.K. KELLER, KILLION, MAJOR, MILNE, O'NEILL, PICKETT, RAPP, SAYLOR, SWANGER, VULAKOVICH AND WATSON, JANUARY 24, 2011

REFERRED TO COMMITTEE ON HEALTH, JANUARY 24, 2011  

AN ACT

Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An

act to consolidate, editorially revise, and codify the public

welfare laws of the Commonwealth," in public assistance,

providing for prepayment pharmacy audits.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  The act of June 13, 1967 (P.L.31, No.21), known

as the Public Welfare Code, is amended by adding a section to

read:

Section 457.1.  Prepayment Pharmacy Audits.--(a)  The

department shall utilize auditing software for the purpose of

analyzing pharmacy claims to identify abnormalities or patterns

of misuse for further investigation prior to any Medical

Assistance pharmacy payments made to a participating pharmacy

provider.

(b)  Medical Assistance payments shall not be made to

providers for pharmacy claims if abnormalities or patterns of

misuse are identified.

(c)  Medical Assistance payments for pharmacy claims may be

made once payments are justified for pharmaceutical claims which

have been identified for investigation.

(d)  Medical Assistance pharmacy claims shall be made by the

department in a timely manner.

Section 2.  This act shall take effect in 60 days.