CS for Senate Bill No. 38(L&C) - Summary

• Pharmacy benefits managers must register with the director as third-party administrators and renew registration biennially with a self-supporting fee to conduct business in Alaska.

• Establishes pharmacy audit procedures including a maximum two-year audit lookback period, 10 business days' advance notice for initial on-site audits, limits of one audit per pharmacy per 12 months and 250 prescriptions per audit (unless fraud alleged), and requirements that audits involving clinical judgment be conducted by or with a licensed pharmacist.

• Prohibits pharmacy benefits managers from basing overpayment findings on projections or extrapolation (except in settlement agreements using statistically justifiable methods), restricts recoupment practices, and limits assessments of dispensing fees in overpayment findings.

• Requires pharmacy benefits managers to provide preliminary audit reports within 60 days, allow pharmacies 30 days to respond, and deliver final reports within 120 days; establishes written appeals processes and prohibits chargebacks until appeals are exhausted.

• Requires pharmacy benefits managers to establish and maintain updated multi-source generic drug pricing lists with transparent methodology, provide appeals processes for reimbursement disputes resolved within 10 days, and allow director hearings for denied appeals with potential claim adjustments.

• Effective July 1, 2019.