MS HB128

Reduces the audit lookback period for pharmacy claims from two years to 90 days from the date claims were submitted or adjudicated by pharmacy benefit managers, insurance companies, or other third-party payors.

Requires audit contracts to detail audit procedures, with entities providing two weeks' written notice before on-site audits and allowing pharmacies 14 days to respond to desk audit requirements.

Prohibits audits from interfering with pharmacy operations, restricts audits involving clinical judgment to pharmacist-conducted reviews, and limits non-targeted audits to 100 randomly selected prescriptions.

Establishes specific audit parameters for eyedrops (one 30-day copayment per bottle), insulin (highest prescribed dose determines day supply), and topical products (determined by pharmacist judgment).

Requires preliminary audit reports within 120 days of audit conclusion, allows pharmacies 30 days to provide documentation, and prohibits recoupments until after completion of the appeals process; effective July 1, 2019.