Senate Bill No. 993 seeks to amend the Pharmacy Audit Integrity Act by refining the regulations surrounding pharmacy benefits managers (PBMs) and their auditing processes. The bill introduces clearer definitions for terms such as "audit" and "disaster declaration," and establishes new requirements for preliminary audit findings and final audit results. It prohibits fines on pharmacies unless there is a valid recoupment under the Act, expands the limits on the number of claims that can be audited annually, and ensures that audits do not disrupt pharmacy operations. Additionally, clerical errors are not classified as fraud unless intent is proven.

The legislation outlines specific procedures for audits, including the necessity of written notice to pharmacies before audits, a clear appeals process for unfavorable findings, and the requirement to notify the Attorney General in cases of suspected fraud. It also establishes a timeline for audit findings and allows pharmacies to electronically reverse and resubmit claims. Notably, the bill introduces a tolling period for audits during declared disasters, extending response times for pharmacies, while clarifying that audits for suspected fraud are exempt from this provision. The Attorney General is empowered to enforce compliance and impose penalties for violations, ultimately aiming to enhance transparency and fairness in pharmacy audits while safeguarding pharmacies during emergencies.

Statutes affected:
Introduced: 59-356.1, 59-356.2, 59-356.3, 59-357, 59-358
Committee Substitute: 59-356.1, 59-356.2, 59-356.3, 59-357, 59-358
Floor (Senate): 59-356.1, 59-356.2, 59-356.3, 59-357, 59-358