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, ensuring that pharmacies are not required to provide unnecessary information during claims reviews.

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 general audit rules. It mandates that the commissioner of insurance establish rules governing the standards for pharmacy record audits, claims reviews, and related procedures, ensuring compliance with the Administrative Procedure Act. Overall, the bill aims to enhance the regulatory framework surrounding pharmacy audits while protecting pharmacies from excessive information requests.

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)