The proposed bill, General Assembly Committee Bill No. 6091, aims to establish an equitable Medicaid audit, billing, and reimbursement policy specifically for pharmacies. Effective July 1, 2025, the bill prohibits the Commissioner of Social Services from using extrapolation of data derived from clerical or minor technical errors as a basis for denying Medicaid reimbursements to pharmacies. Additionally, the bill mandates the commissioner to implement a receipt confirmation process for pharmacy billing notices and to maintain a reliable, real-time database of the preferred drug list, which includes updates on drug approvals and denials.

Furthermore, by October 1, 2025, the commissioner is required to create a grievance process that allows pharmacies to contest Medicaid reimbursements for prescribed drugs that do not cover their dispensing costs. This process will enable pharmacies to present evidence comparing their costs to the disputed reimbursement amounts. The overall purpose of the bill is to ensure a fair and transparent process for pharmacies in relation to Medicaid billing and reimbursements.