The proposed legislation, General Assembly Raised Bill No. 5354, aims to alleviate the burdens placed on pharmacies during Medicaid audits. Effective July 1, 2026, the bill stipulates that the Commissioner of Social Services cannot deny Medicaid reimbursements to pharmacies based on extrapolated data derived from clerical or minor technical errors identified in audits. Additionally, the commissioner is required to establish a process to confirm that pharmacies receive all relevant notices from the department and to maintain an accessible, real-time database of the preferred drug list, including updates on drug approvals and denials.

Furthermore, by October 1, 2026, the commissioner must implement 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 reimbursements. Overall, the bill seeks to enhance transparency and fairness in the Medicaid reimbursement process for pharmacies.