CS/HB 1155 Summary

• Transfers and renumbers pharmacy audit requirements from section 465.1885 to section 624.491, applying them to audits conducted by health insurers, health maintenance organizations, and pharmacy benefit managers.

• Expands pharmacy rights during audits to include 7-day advance notice, restrictions on audit timing, 24-month claim lookback limits, pharmacist consultation for clinical audits, use of practitioner records for validation, reimbursement for administrative errors, preliminary and final audit report deadlines, 10 business days to address findings, and prohibition on extrapolation-based recoupments.

• Allows audited pharmacies to appeal final audit report findings regarding whether claim payments are due and claim payment amounts pursuant to section 408.7057.

• Holds health insurers and health maintenance organizations responsible for violations of pharmacy audit requirements even when they contract with pharmacy benefit managers to handle payment obligations.

• Establishes a $10,000 fine per violation for any person operating as a pharmacy benefit manager without registering with the office; effective July 1, 2021.