MN SF973

Establishes a pharmacy audit integrity program to set standards for audits of pharmacy records conducted by pharmacy benefits managers (PBMs) and their representatives.

Requires pharmacies receive written notice before on-site audits, audits involving clinical judgment be conducted by or with a licensed pharmacist, and all similarly situated pharmacies be audited under the same standards.

Limits audit lookback period to 24 months from claim submission, caps statistical samples at 60 prescriptions, prohibits audits during the first seven business days of the month without consent, and bans auditor access to patient-specific information areas.

Prohibits extrapolation and payment-based compensation for auditors, restricts recoupments to actual overpayments without dispensing fees, and prohibits fraud designations for clerical or recordkeeping errors.

Requires preliminary reports within 30 days of audit conclusion, allows pharmacies 30 days to respond, mandates final reports within 90 days, establishes written appeals and mediation processes, and prohibits chargebacks until appeals are exhausted.