Audit and Prescription compliance

North Carolina created the same type of legislation prior to Florida. BCBS (PBM) did an audit and found limited compliance with the law in North Carolina. Will Florida suffer the same lack of compliance? What would you have done differently?

The question refers to House Bill 21. The question I want you to think about is the auditing of the prescription data for compliance of House Bill 21. North Carolina has a similar type of legislation that Florida enacted basically quantity limits and documentation required for controlled substance prescriptions. The audit in North Carolina by Bluecross Blue Shield showed they have a potential compliance issue with the North Carolina legislation. Florida may have the same problem. Would you audit the prescription data? Do you think auditing is needed? Would you audit the clinic or hospitals EMAR for some pain exception documentation? (not currently done) Florida put penalties in place for providers and pharmacists if HB21 is not followed. None of that matters if they don’t audit the process. Also consider that the next step of HB21 is an actual pain management plan for most patients on opiates. Imagine the audit for compliance. Another thought on auditing is the Narcan rescue prescriptions. Some providers may actually just write this to cover all patients. If you are familiar with P(plan)D(do)C(check)A(act) what I’m asking about is the C (check) part of process improvement. The process improvement is the legislation.

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