Rebate contracts must be open to audit by an auditor the plan picks and pays
What the document says“Audits carried out under clauses (ii)(III) and (iv) shall be performed by an auditor selected by the responsible plan fiduciary. Payment for such auditors shall not be made, whether directly or indirectly, by the entity providing pharmacy benefit management services.”
The records of the rebates and disclosures must be available for audit by the plan at least once a plan year. A third-party administrator, issuer or covered service provider must make rebate contracts with rebate aggregators or manufacturers available for audit, subject to reasonable confidentiality restrictions the Secretary determines. The auditor is chosen by the responsible plan fiduciary and may not be paid, directly or indirectly, by the pharmacy benefit manager.
What the document actually says“Audits carried out under clauses (ii)(III) and (iv) shall be performed by an auditor selected by the responsible plan fiduciary. Payment for such auditors shall not be made, whether directly or indirectly, by the entity providing pharmacy benefit management services.”
The plan officer picks who does the audit. The drug middleman may not pay that auditor, whether straight out or through someone else.
An auditor paid by the firm being checked is not really free. The plan picks and pays. The plan may look at the rebate deals themselves.
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