The 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 written notifications to pharmacies prior to audits. The bill mandates that audits must not disrupt patient care and sets specific guidelines for documentation and recoupment processes. It also introduces a written audit appeals process and stipulates that recoupment can only occur after all appeals are resolved and a final audit report is issued.

Additionally, the bill empowers the Office of Insurance Regulation to enforce these regulations, including the authority to impose fines for violations and to suspend or revoke the registration of pharmacy benefit managers under certain conditions. The legislation aims to protect pharmacies from unfair audit practices and ensure compliance with established standards, while also providing a framework for addressing fraud, waste, or abuse in pharmacy operations. The act is set to take effect on July 1, 2026.

Statutes affected:
H 1209 Filed: 624.491