DE HB364

Establishes comprehensive audit requirements for pharmacy benefit managers (PBMs) auditing contracted pharmacies and pharmacists, excluding audits involving suspected fraud or willful misrepresentation.

Prohibits PBMs from scheduling onsite audits to begin during the first 5 calendar days of a month unless requested by the pharmacy, and requires at least 14 days written notice before conducting initial onsite audits.

Limits audit scope to claims submitted or adjudicated within the 2-year period preceding the audit and prohibits PBMs from using extrapolation to calculate overpayments or underpayments.

Requires PBMs to deliver preliminary audit reports within 120 calendar days and final reports within 6 months (or 30 days if internal appeal is requested), and prohibits recoupment of overpayments until 30 working days after final report delivery unless identified discrepancies exceed $25,000.

Establishes an internal appeals process allowing pharmacies 30 working days after receipt of preliminary audit report to dispute claims, and requires PBMs to remit underpayments within 30 working days of final report delivery.