HI SB1244

Establishes procedures for on-site audits of pharmacy prescription drug benefit claims conducted by health care providers, insurance companies, third-party payors, and related entities.

Requires auditors to provide at least one week advance notice before initial on-site audits and allows pharmacies at least 14 days to respond to preliminary findings.

Mandates that audits involving clinical or professional judgment be conducted by or in consultation with a licensed pharmacist.

Prohibits criminal penalties for clerical or record-keeping errors without proof of intent to commit fraud, and allows recoupment only for actual overpayments unless otherwise agreed in settlement.

Limits audit periods to two years from claim submission date and restricts recoupments to 18 months after final internal disposition, with a mandatory 30-day appeal period for pharmacies to challenge findings.