NJ S3535

Requires entities auditing pharmacies to provide at least 14 days advance notice with a list of claims to be audited, limited to 100 prescriptions per audit and 200 per 12-month period.

Prohibits recoupment of funds except in cases of fraud, overpayment errors (limited to the amount overpaid), or misfills, and bars the use of extrapolation in calculating recoupments or penalties.

Mandates that audits involving clinical or professional judgment be conducted by or in consultation with a pharmacist, and that clerical or record-keeping errors alone do not constitute fraud.

Establishes an internal appeals process giving pharmacies at least 30 days to appeal unfavorable preliminary audit reports, with recoupment only allowed after final disposition including appeals.

Assigns enforcement to the Commissioner of Banking and Insurance, who may investigate complaints, prohibit or order reimbursement of wrongful recoupments, and impose fines for violations.