The bill amends and reenacts several sections of Louisiana's Revised Statutes related to pharmacy record audits, specifically R.S. 22:1852 and R.S. 22:1856.1. It updates the definition of "health insurance issuer" to include not only insurance companies and health maintenance organizations but also pharmacy benefit managers and individuals acting on their behalf. The bill clarifies that audits of pharmacy records must adhere to specific criteria, including the prohibition of requiring pharmacies to provide information unrelated to the claims under review.

Additionally, the bill introduces new provisions regarding the enforcement of pharmacy record audits, stating that certain quality assurance reviews and investigations related to suspected fraud or misrepresentation are exempt from the standard audit procedures. It mandates that the commissioner of insurance develop rules to establish standards for conducting pharmacy record audits, claims reviews, and investigations into fraud or misrepresentation, ensuring compliance with the Administrative Procedure Act.

Statutes affected:
SB281 Original: 22:1852(7), 22:1(B), 22:1(B)(2)
SB281 Engrossed: 22:1852(7), 22:1(B), 22:1(B)(2)
SB281 Reengrossed: 22:1852(7), 22:1(B), 22:1(B)(2)
SB281 Enrolled: 22:1852(7), 22:1(B), 22:1(B)(2)
SB281 Act 514: 22:1852(7), 22:1(B), 22:1(B)(2)