SB0757 Summary: Pharmacy Audits

• Adds Section 513b7 to the Illinois Insurance Code establishing comprehensive regulations for pharmacy audits conducted by pharmacy benefit managers and auditing entities.

• Prohibits on-site audits during the first 3 business days of each month, first and final 2 weeks of the calendar year, or during declared public health emergencies; requires 14 business days' written notice before initial on-site audits.

• Limits audits to 100 prescriptions per audit and 200 prescriptions per 12-month period (except for suspected fraud, waste, or abuse cases); restricts audit lookback period to 24 months after claim submission; prohibits auditing the same pharmacy more than once every 6 months.

• Prohibits use of extrapolation to calculate penalties or chargebacks unless required by federal law; prohibits charging back dispensing fees unless the prescription is a misfill, not delivered, invalid, or prescriber-denied; prohibits compensating auditors based on percentage of amounts recouped.

• Establishes appeal rights for pharmacies, requires final audit reports within 90 days, prohibits chargebacks until appeals process concludes (unless discrepancy exceeds $25,000), and sets specific parameters for calculating day supplies for eyedrops, insulin, and topical products based on manufacturer recommendations.