This bill amends Section 624.491 of the Florida Statutes to enhance regulations surrounding pharmacy audits conducted by pharmacy benefit plans or programs. Key revisions include the establishment of uniform audit standards, limitations on audit methodologies, and requirements for documentation and reporting. The bill mandates that audits must not disrupt patient care and must be conducted in a manner that does not impose stricter requirements on nonaffiliated pharmacies compared to those owned or affiliated with pharmacy benefit managers. Additionally, it introduces specific provisions for audits designated as fraud, waste, or abuse audits, requiring them to be based on credible evidence and providing pharmacies with clear communication regarding the basis for such designations.

The bill also outlines enforcement mechanisms, granting the Office of Insurance Regulation the authority to investigate violations, issue fines, and impose administrative penalties. It specifies that recoupment of funds must be based on actual overpayments and prohibits the use of extrapolation unless agreed upon in writing. The legislation aims to protect pharmacies from unfair audit practices while ensuring compliance with established standards. The effective date for these changes is set for July 1, 2026.

Statutes affected:
S 1256 Filed: 624.491