Tennessee Senator Shane Reeves | PBM Reform Podcast Series

Tennessee Gov. Bill Lee signed HB 786, a comprehensive PBM reform bill that strengthens existing fair pharmacy audit laws, limits PBM adjudication fees, and prohibits a PBM from reimbursing a pharmacy less than it reimburses a PBM-affiliated pharmacy.May 30, 2019 Tennessee SB650 Present law defines "pharmacy benefits manager" (PBM) to mean a person, business, or other entity and any wholly or partially owned subsidiary of the entity, that administers the medication and/or device portion of pharmacy benefits coverage provided by a health insurance plan, subject to certain exceptions. Present law provides detailed requirements for the conduct of an audit of records of a pharmacist or pharmacy by a health insurance plan, a PBM, the state or its political subdivisions, or any other entity representing the same. One such audit requirement is that a clerical or recordkeeping error regarding a required document or record may not, in and of itself, constitute fraud; however, the claims may be subject to recoupment. This bill instead provides that a clerical or recordkeeping error identified during an audit is not prima facie evidence of fraud or intentional misrepresentation and must not be the basis of a recoupment unless the error results in an actual overpayment to the pharmacy or the wrong medication being dispensed to the patient. As under present law, a clerical error will not be subject to criminal penalties without proof of intent to commit fraud.  Shane Reeves is an American businessman, pharmacist and politician who is the State Senator for the 14th District of Tennessee, which is composed of Bedford County, Moore County, Lincoln County, Marshall County, and part of Rutherford County. As a seventh-generation Tennessean, Senator Shane Reeves has spent his life raising a family and opening businesses in middle Tennessee. He understands the importance of family, character, and conservative values to the people in this community. See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices