This bill amends existing Louisiana law regarding pharmacy claims and audits. It modifies the definitions of terms related to health insurance issuers, clarifying that this includes not only insurance companies but also pharmacy benefit managers and their representatives. The language changes from "shall be" to "are" in the definitions section, indicating a more definitive stance on the terms used. Additionally, the bill specifies that audits of pharmacy records must adhere to certain criteria, ensuring that while claims can be reviewed for payment accuracy, pharmacies are not required to provide unrelated information.

Furthermore, the bill introduces a new section that mandates the commissioner to develop standards for policies and procedures governing pharmacy record audits, claims reviews, and quality assurance reviews, as well as audits related to fraud or misrepresentation. This aims to create a more structured and regulated environment for pharmacy audits, enhancing the protection of pharmacies while ensuring compliance with necessary review processes.

Statutes affected:
HB603 Enrolled: 22:1852, 22:1(B)(2)
HB603 Act 658: 22:1852, 22:1(B)(2)