Sections
12 entriesSection 4430Defines pharmacy-audit terms including carrier, clerical or recordkeeping error, extrapolation, health benefit plan, maximum allowable cost, obsolete drug, pharmacy, pharmacy audit, and…Section 4431Exempts from the pharmacy-audit chapter an audit conducted because a pharmacy benefit manager, carrier, plan sponsor, or other third-party payer has indications…Section 4432Requires pharmacy-service contracts issued, amended, or renewed on or after January 1, 2013 between a pharmacy and a carrier or pharmacy benefit…Section 4433Prohibits a pharmacy-audit entity from being paid based on amounts claimed or recovered, but permits a pharmacy benefit manager or health plan…Section 4434Requires pharmacy-audit entities to keep audit information confidential, subject to law, and limits access to prior reports to audits by or for…Section 4435Prohibits an entity conducting an onsite pharmacy audit from initiating or scheduling the audit during the first five business days of a…Section 4436Requires pharmacy audits involving clinical judgment to be conducted by or with a licensed pharmacist, requires prescription-validity determinations to follow the specified…Section 4437Limits the period examined in a pharmacy audit to no more than 24 months from the date the claim was submitted to…Section 4438Requires a preliminary pharmacy-audit report within 60 days after the audit, at least 30 days for the pharmacy’s response, a final report…Section 4439Limits interpretation of the pharmacy-audit chapter by stating that it does not suggest or imply that either the Department of Consumer Affairs…Section 4440Requires pharmacy benefit managers using maximum-allowable-cost reimbursement to disclose pricing sources in contracts entered or renewed from January 1, 2016, provide current…Section 4441Requires pharmacy benefit managers, for contracts entered, amended, or renewed on or after January 1, 2019, to act in good faith, disclose…