CT SB00955

Establishes new regulations for pharmacy audits conducted by pharmacy benefits managers and plan sponsors, effective October 1, 2013, requiring written agreements between auditing entities and pharmacies with 14 calendar days' prior written notice before conducting audits.

Prohibits audits during the first five business days of any month unless agreed to by the pharmacy, limits audits to claims submitted within 24 months, and requires audits involving clinical judgment to be conducted by or in consultation with a licensed pharmacist.

Requires preliminary audit reports within 60 days of audit conclusion with at least 30 days for pharmacy response, followed by a final report within 120 days that considers pharmacy responses; establishes a pharmacy appeal process with minimum 30-day filing period.

Prohibits charge-backs or recoupments for clerical or recordkeeping errors unless they caused actual financial harm, and prohibits any payment to auditing entities based on the amount of recoupments collected from pharmacies.

Repeals and modifies existing pharmacy benefits manager registration requirements in state statute, removing transition provisions and cross-referencing the new pharmacy audit section in related statutes.