HB 38 Summary

• Establishes the Pharmacy Audit Integrity Program to regulate audits of pharmacy records by pharmacy benefits managers (PBMs) and entities representing them.

• Requires PBMs to provide 14 days' notice before on-site audits, conduct audits with licensed pharmacist involvement for clinical matters, apply consistent standards across similarly situated pharmacies, and supply prescription number ranges in advance.

• Limits audit lookback periods to 24 months from claim submission/adjudication, prohibits extrapolation in calculating recoupments unless required by law, and prevents auditor compensation based on recovery percentages.

• Requires preliminary audit reports within 30 days and final reports within 120 days, allows pharmacies 45 days to respond to discrepancies, and mandates written appeals processes for audit findings.

• Takes effect 90 days after enactment and does not apply to audits involving suspected fraud, willful misrepresentation, abuse, or audits completed by the State.