FL H1093

Establishes standards for pharmacy audits conducted by pharmacy benefit managers and related entities, requiring uniform standards and parameters applied to all pharmacies.

Requires at least 30 days' written notice before onsite audits with specific prescription numbers identified; limits initial audits to 1 percent of average monthly claims or 200 claims maximum; prohibits audits during the first 7 days of each month.

Mandates clinical or professional audits be conducted by or with consultation of a licensed pharmacist; prohibits interest accrual during audits; prohibits recoupment for clerical errors unless fraud intent or actual financial harm is proven.

Requires preliminary audit reports within 60 days of audit conclusion with 30-day response period for pharmacies; final reports within 120 days; establishes written appeal process with option for health plan sponsor review and mediation.

Applies to contracts entered into, amended, extended, or renewed on or after July 1, 2012; does not apply to Medicaid audits or investigative audits involving fraud or willful misrepresentation; effective July 1, 2012.