HB 1225 Summary

• Extends pharmacy audit protections to third-party payors and third-party administrators in addition to Medicaid, with audit criteria applying to claims submitted after July 1, 2011

• Prohibits using extrapolation as an accounting practice for calculating penalties or recoupment in Medicaid, third-party payor, or third-party administrator audits

• Exempts claims containing only clerical or recordkeeping errors (typographical, scrivener's, or computer errors) from financial recoupment if the claim is otherwise valid

• Requires audits to be conducted by licensed pharmacists, with at least 1 week prior notice, 10 days to produce documentation, and audit reports delivered within 90 days of conclusion

• Prohibits third-party payors and state agencies from mandating mail delivery of pharmacy services and prescription drugs, though they may offer incentivized mail programs