FL H1209

Requires uniform audit standards for all pharmacies in a pharmacy benefit manager's network, prohibiting stricter methodologies or more frequent audits for non-affiliated pharmacies compared to PBM-owned pharmacies

Increases advance notice for audits from 7 to 30 calendar days, limits audits to 0.1% random sampling of prescriptions, and restricts the audit period to 24 months after claim submission

Prohibits recoupment based on extrapolation (except in fraud settlements), limits recoupment to dispensing fees unless fraud is proven, and requires all appeals to be resolved before any recoupment occurs

Establishes specific requirements for fraud, waste, or abuse audits including written documentation of specific evidence or allegations before the audit begins, and prohibits using this designation to circumvent standard audit protections

Authorizes the Office of Insurance Regulation to impose fines up to $100,000 per violation for misuse of fraud designations, up to $50,000 for discriminatory audit practices, and up to $25,000 for other violations, with authority to suspend or revoke PBM registrations for repeated violations