HI HB1134

Establishes procedures for pharmacy audits conducted by health care providers, insurance companies, pharmacy benefit managers, third-party payors, and related entities under Hawaii Revised Statutes Chapter 431R.

Requires auditors to provide pharmacies at least two weeks' written notice before initial audits and prohibits audits during the first seven days of each month unless the pharmacy consents.

Prohibits use of extrapolation in calculating recoupments or penalties and limits audit periods to one year from the date a claim was submitted or adjudicated.

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

Requires auditors to establish a written appeals process allowing pharmacies at least 30 days to appeal preliminary findings, with interest accruing only after the appeals process is exhausted and final findings are delivered.

Effective July 1, 2021, and applies only to claims submitted for payment after that date.