FL S1256

Requires pharmacy benefit managers (PBMs) and insurers to apply uniform audit standards to all network pharmacies, prohibiting stricter audit practices on non-affiliated pharmacies compared to PBM-owned pharmacies

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

Prohibits recoupment based on extrapolation and limits recoupment to dispensing fees only unless fraud is proven; ingredient cost recoupment requires proof of fraud or willful misrepresentation

Establishes strict requirements for fraud, waste, or abuse audit designations, requiring specific documented evidence and written notice to the pharmacy before such audits can proceed

Authorizes the Office of Insurance Regulation to impose fines up to $100,000 per violation for misuse of fraud designations, order restitution for improper recoupments, and suspend or revoke PBM registrations for repeated violations