Sec. 1369.256. AUDIT REQUIRING PROFESSIONAL JUDGMENT. A health benefit plan issuer or pharmacy benefit manager that conducts an on-site audit or a desk audit involving a pharmacist's clinical or professional judgment must conduct the audit in consultation with a licensed pharmacist.
Added by Acts 2013, 83rd Leg., R.S., Ch. 915 (H.B. 1358), Sec. 1, eff. September 1, 2013.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle E - Benefits Payable Under Health Coverages
Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services
Subchapter F. Audits of Pharmacists and Pharmacies
Section 1369.252. Exceptions to Applicability of Subchapter
Section 1369.253. Conflict With Other Laws
Section 1369.254. Audit of Pharmacist or Pharmacy; Notice; General Provisions
Section 1369.255. Completion of Audit
Section 1369.256. Audit Requiring Professional Judgment
Section 1369.257. Access to Pharmacy Area
Section 1369.258. Validation Using Certain Records Authorized
Section 1369.2581. Audit Discrepancies; Wholesale Invoices
Section 1369.259. Calculation of Recoupment; Use of Extrapolation Prohibited
Section 1369.260. Clerical or Recordkeeping Error; Fraud Allegation
Section 1369.261. Access to Previous Audit Reports; Uniform Audit Standards
Section 1369.262. Compensation of Auditor
Section 1369.263. Conclusion of Audit; Summary; Preliminary Audit Report
Section 1369.264. Final Audit Report
Section 1369.265. Certain Audits Exempt From Deadlines
Section 1369.266. Recoupment and Interest Charged After Audit
Section 1369.267. Waiver Prohibited
Section 1369.268. Remedies Not Exclusive