House Bill 291 - Fair Pharmacy Audits Act Summary

• Establishes minimum uniform standards for pharmacy audits conducted on or after July 1, 2023, with exemptions for Medicaid audits, investigative audits based on fraud suspicion, and financial examinations by certified public accountants.

• Requires auditors to provide 14 days' written notice before on-site audits, limits audits to 250 prescriptions per calendar year, and prohibits charge-backs for clerical errors unless they resulted in overpayment to the pharmacy.

• Mandates preliminary audit reports within 60 days and gives pharmacies 60 days to respond with documentation; prohibits recoupment of disputed funds until after completion of appeals process.

• Prohibits extrapolation audits except when required by federal law, and prevents auditors from using information from audits on one pharmacy to conduct audits for other clients.

• Requires written appeals process for pharmacies to challenge audit findings and referral of reports containing potential criminal conduct findings to the prosecuting attorney upon completion of appeals.