SB 483 Summary

• Expands applicability of Alabama pharmaceutical insurance coverage regulations to pharmacy benefit management plans administered by managed care companies, nonprofits, health benefit plans, third-party payors, and state health programs.

• Establishes new requirements for pharmacy benefit managers including 30-day notice of contract changes, prohibits mandating specific pharmacies, prevents automatic enrollment/disenrollment without written consent, and restricts use of pharmacy data without express consent.

• Requires 90-day prescription drug supplies at community pharmacies without additional copayments or restrictions compared to mail order pharmacies, and allows prorated cost-sharing for less-than-30-day supplies when medically appropriate or for medication synchronization.

• Significantly reforms pharmacy audit procedures by requiring 30-day advance notice of on-site audits, limiting audits to 40 prescriptions and four hours duration, requiring licensed pharmacist involvement in clinical audits, and prohibiting recoupment based on clerical errors without proof of fraud.

• Limits audit lookback period to six months, restricts auditor access to previous reports, prohibits auditor compensation based on amounts recovered, and requires preliminary reports within 30 days and final reports within 30 days of appeal completion.