The bill amends the Pharmacy Audit Integrity Act to strengthen regulations governing pharmacy benefit managers (PBMs) and their auditing processes. Key changes include a requirement for PBMs to provide written notice to pharmacies at least 14 days before an audit, detailing specific prescription information, and a prohibition on assessing fines unless there is a valid recoupment under the Act. The bill also limits the number of prescription claims that can be audited annually and mandates timely delivery of preliminary and final audit findings reports. Additionally, it establishes an appeals process for pharmacies contesting unfavorable audit results and requires that any findings of fraud or willful misrepresentation be reported to the appropriate legal authorities.

Further amendments include provisions for the Attorney General to grant extensions for audits, the inclusion of specific details in audit findings reports, and the pausing of PBM audits during declared disasters and for 30 days afterward. The bill also outlines licensing requirements for PBMs, including the necessity of a surety bond and compliance with Insurance Department regulations. It empowers the Attorney General to impose fines for violations and ensures that the timeframe for filing below-cost reimbursement appeals is extended during disaster declarations. Overall, the bill aims to enhance transparency and accountability in pharmacy audits while providing necessary protections for pharmacies, particularly during emergencies.

Statutes affected:
Introduced: 59-356.1, 59-356.2, 59-356.3, 59-357, 59-358