HB 6 - Pharmacy Audits

• Establishes procedures and guidelines for audits of pharmacy records conducted by insurers, managed care companies, hospitals, third-party payors, and pharmacy benefits managers.

• Requires auditors to provide at least two weeks' notice before initial on-site audits and prohibits audits during the first seven business days of a month or within 90 days of a previous audit with no errors found.

• Restricts auditors from using extrapolation to calculate overpayments or underpayments, limits audits to claims submitted within two years, and requires clinical audits to be conducted by or with consultation from a licensed pharmacist.

• Grants pharmacies 30 days after receiving preliminary audit reports to provide documentation addressing discrepancies and requires written appeal processes for unfavorable audit findings.

• Prohibits auditor compensation based on recovery percentage, protects patient information confidentiality, and excludes criminal investigations and governmental agency audits from these requirements; effective January 1, 2014.