The bill amends the Pharmacy Audit Integrity Act to improve the auditing process for pharmacies conducted by pharmacy benefits managers (PBMs). Key changes include the introduction of specific definitions related to audits, such as "audit," and new requirements for preliminary and final audit findings reports. Pharmacies must receive written notice of audits at least 14 days in advance, detailing the prescriptions being audited. The bill prohibits PBMs from imposing fines or penalties unless there is a valid recoupment under the Act and allows pharmacies to correct clerical errors without facing recoupment. Additionally, it expands pharmacies' rights during audits, including the ability to appeal unfavorable findings and limits the number of prescription claims that can be audited annually.

Furthermore, the bill enhances the transparency and fairness of the Maximum Allowable Cost (MAC) pricing system for pharmacy providers. It mandates that MAC pricing be updated at least every seven days and ensures that drugs on the MAC list are FDA-rated A or B and available from wholesalers. The bill prohibits the inclusion of dispensing fees in MAC price calculations and establishes a clear appeals process for providers contesting reimbursement amounts, requiring PBMs to respond within ten days. It also protects pharmacies from below-cost reimbursements and allows for tolling of appeal filing periods during disaster declarations. Overall, the legislation aims to create a more equitable environment for pharmacies while ensuring compliance and accountability from PBMs.

Statutes affected:
Introduced: 59-356.1, 59-356.2, 59-356.3, 59-357, 59-358
House Committee Substitute for Senate Bill: 59-356.1, 59-356.2, 59-356.3, 59-357, 59-358, 59-360
Committee Substitute: 59-356.1, 59-356.2, 59-356.3, 59-357, 59-358
Floor (House): 59-356.1, 59-356.2, 59-356.3, 59-357, 59-358, 59-360
Floor (Senate): 59-356.1, 59-356.2, 59-356.3, 59-357, 59-358
Engrossed: 59-356.1, 59-356.2, 59-356.3, 59-357, 59-358, 59-360
Amended And Engrossed: 59-356.1, 59-356.2, 59-356.3, 59-357, 59-358, 59-360
Enrolled (final version): 59-356.1, 59-356.2, 59-356.3, 59-357, 59-358, 59-360