HB457 Summary

• Amends Alabama Code Sections 34-23-181, 34-23-184, 34-23-185, and 34-23-186 to establish and strengthen auditing procedures for pharmacy records by health benefit plans and pharmacy benefit managers.

• Prohibits auditing entities from considering clerical, record-keeping, typographical, or computer errors as fraud, and prevents recoupment unless the error resulted in actual overpayment to the pharmacy.

• Requires pharmacy audits to be conducted by or in consultation with licensed pharmacists for issues involving clinical or professional judgment, with at least two weeks' written notice and sample sizes limited to 150 prescriptions.

• Establishes audit timelines including preliminary reports within 90 days, 30-day pharmacy response period, and final reports within 180 days; limits audit lookback period to two years from claim submission date and prohibits audits six months after contract termination.

• Prohibits use of extrapolation methodology for calculating recoupments and penalties, and forbids auditing entities from compensating employees or contractors based on recoupment amounts.