SB 1310 Summary

• Establishes standards for audits of pharmacy records conducted by pharmacy benefit managers and other entities that finance or reimburse health services.

• Requires audits to use consistent standards across all pharmacies, involve licensed pharmacists for clinical judgments, provide 30 days' notice before onsite audits, and limit initial audits to 1% of average monthly prescription claims (not exceeding 200 claims).

• Prohibits auditing companies from receiving payment based on a percentage of recovered amounts, collecting disputed funds before appeals are complete, and including clerical errors in recoupment unless fraud or financial harm is proven.

• Requires preliminary audit reports within 60 days of audit conclusion, allows pharmacies 30 days to respond, and mandates final reports within 120 days; prohibits chargebacks or recoupment until the appeal process is exhausted.

• Applies to contracts entered into, amended, extended, or renewed on or after July 1, 2012, with exceptions for Medicaid audits and investigative audits involving fraud or willful misrepresentation.