AZ SB1165

Amends section 20-3322 of Arizona Revised Statutes regarding pharmacy audit procedures and claim payment restrictions.

Requires auditing entities to provide at least 14 days' written notice, avoid auditing during the first five days of the month without pharmacy consent, and limit audits to claims not exceeding two years from adjudication.

Prohibits auditing entities from retroactively reducing claim payments after adjudication unless the claim was fraudulently submitted, was a duplicate payment, or contained errors resulting in overpayment.

Establishes that audits involving clinical or professional judgment must be conducted by or in consultation with a pharmacist, and audits must base findings on actual overpayment/underpayment rather than projections.

Specifies that dispensing fees cannot be included in overpayment findings except in cases of non-delivery, lack of prescriber authorization, medication errors, or when the overpayment is solely based on an extra dispensing fee.