§ 73-21-191. Penalty for noncompliance with Sections 73-21-175 through 73-21-189
The State Board of Pharmacy may impose a monetary penalty on pharmacy benefit managers for noncompliance with the provisions of the Pharmacy Audit Integrity Act, Sections 73-21-175 through 73-21-189, in amounts of not less than One Thousand Dollars ($1,000.00) per violation and not more than Twenty-five Thousand Dollars ($25,000.00) per violation.The board shall prepare a […]
§ 73-21-201. Short title
Sections 73-21-201 through 73-21-205 shall be known as the “Prescription Drugs Consumer Affordable Alternative Payment Options Act.”
§ 73-21-203. Definitions
For the purposesof Sections 73-21-201 through 73-21-205: “Board”shall have the same definition as provided in Section 73-21-73. “Pharmacist,””pharmacist services” and “pharmacy” or”pharmacies” shall have the same definitions as providedin Section 73-21-73. “Pharmacybenefit manager” shall have the same definition as providedin Section 73-21-179.
§ 73-21-205. Pharmacists authorized to provide additional information to patients to allow them to consider affordable alternative payment options when acquiring prescription medication; provisions of contracts or agreements contrary to Sections 73-21-201 through 73-21-205 are void; compliance with this section does not constitute violation of contract or agreement to which pharmacist is party; protection for pharmacists acting or failing to act under this section
Pharmacists mayprovide additional information to a patient to allow them an opportunityto consider affordable alternative payment options when acquiringtheir prescription medication. Any provisionof any contract or agreement contrary to the provisions of Sections 73-21-201 through 73-21-205 shall be consideredin violation of public policy and shall be void. Compliance withthis section shall not constitute a violation […]
§ 73-21-179. Definitions
For purposes of Sections 73-21-175 through 73-21-189: “Entity” means a pharmacy benefit manager, a managed care company, a health plan sponsor, an insurance company, a third-party payor, or any company, group or agent that represents or is engaged by those entities. “Health insurance plan” means benefits consisting of prescription drugs, other products and supplies, and […]
§ 73-21-181. Application
Sections 73-21-175 through 73-21-189 shall apply to any audit of the records of a pharmacy conducted by a managed care company, nonprofit hospital or medical service organization, insurance company, third-party payor, pharmacy benefit manager, a health program administered by a department of the state or any entity that represents those companies, groups, or department.
§ 73-21-183. Audit procedures; written report; report requirements
The entity conducting an audit shall follow these procedures: The pharmacy contract must identify and describe in detail the audit procedures; The entity conducting the on-site audit must give the pharmacy written notice at least two (2) weeks before conducting the initial on-site audit for each audit cycle, and the pharmacy shall have at least […]
§ 73-21-185. Appeals; dismissal of audit report; mediation of unresolved issues
Each entity conducting an audit shall establish a written appeals process under which a pharmacy may appeal an unfavorable preliminary audit report to the entity. If, following the appeal, the entity finds that an unfavorable audit report or any portion thereof is unsubstantiated, the entity shall dismiss the audit report or that portion without the […]
§ 73-21-187. Use of extrapolation in calculating recoupments or penalties prohibited
Notwithstanding any other provision in Sections 73-21-175 through 73-21-189, the entity conducting the audit shall not use the accounting practice of extrapolation in calculating recoupments or penalties for audits. An extrapolation audit means an audit of a sample of prescription drug benefit claims submitted by a pharmacy to the entity conducting the audit that is […]
§ 73-21-189. Limitation of applicability of Sections 73-21-175 through 73-21-189
Sections 73-21-175 through 73-21-189 do not apply to any audit, review or investigation that involves alleged fraud, willful misrepresentation or abuse.