AZ HB2692

Establishes audit procedures for pharmacy benefits managers and auditing entities conducting audits of pharmacy drug claims in Arizona, effective for contracts and audits initiated from December 31, 2016 forward.

Requires in-pharmacy audits to have at least 14 days' written notice, prohibits audits during the first five days of the month without pharmacy consent, and limits audits to claims no older than two years from adjudication date.

Prohibits auditing entities from recouping monies for clerical errors and from including dispensing fees in overpayment findings except in specific circumstances (prescription not received, prescriber denial, medication error, or extra dispensing fee only).

Requires auditing entities to deliver preliminary audit reports within 60 days, allow pharmacies 30 days to respond, and deliver final reports within 90 days; establishes written appeals process with at least 30 days to appeal unfavorable findings.

Prohibits chargebacks and recoupments until the appeals process is exhausted and final audit report is issued; bars sharing audit information with entities other than the insurer and restricts auditors to accessing only previous reports from the same auditing entity.