SB 993 Summary

• Establishes strict timelines for pharmacy audits by pharmacy benefits managers (PBMs), including 45-day deadline for preliminary reports and 10-day deadline for final reports, with 90-day response period for pharmacies to provide documentation

• Prohibits PBMs from assessing fines or penalties on pharmacies unless there is a valid recoupment under the Pharmacy Audit Integrity Act, and caps annual audits at 50 prescription claims per PBM per calendar year

• Eliminates use of extrapolation in calculating audit recoupments and requires detailed preliminary and final audit reports including specific prescription numbers, fill dates, drug names, and NDC numbers

• Tolls (pauses) audit timelines and appeal deadlines for pharmacies located in declared disaster areas during the disaster period plus 30 additional calendar days following termination

• Requires PBMs to provide documented proof of wholesaler availability when denying below-cost reimbursement appeals and prohibits collecting additional payments from pharmacies following successful appeals