S.B. 975 Summary

• Establishes regulatory procedures for pharmacy audits conducted by health care providers, insurance companies, third-party payors, and related entities to prevent abusive audit practices.

• Requires audits involving clinical or professional judgment be conducted by or in consultation with a licensed pharmacist or the board of pharmacy.

• Prohibits extrapolation in calculating recoupments or penalties; findings must be based on actual overpayments or underpayments, excluding dispensing fees.

• Grants pharmacies at least 30 days to correct clerical errors or produce documentation after receiving preliminary audit findings, and establishes a written appeals process with at least 30 days to appeal.

• Prohibits chargebacks or penalties until the appeals process is exhausted; prevents auditors from receiving payment based on a percentage of recovered amounts; effective July 1, 2050.