33-2-2001. Short title

33-2-2001. Short title. This part may be cited as the “Pharmacy Audit Integrity Act”. History: En. Sec. 1, Ch. 114, L. 2013.

33-2-2002. Definitions

33-2-2002. Definitions. As used in this part, the following definitions apply: (1) ”Audit” means a review of the records of a pharmacy by or on behalf of an entity that finances or reimburses the cost of health care services or pharmaceutical products. (2) ”Entity” includes: (a) a pharmacy benefits manager; (b) a health benefit plan; (c) a third-party administrator; and (d) a […]

33-2-2003. Applicability

33-2-2003. Applicability. (1) Except as provided in subsection (2), this part applies to an audit of the records of a pharmacy licensed under Title 37, chapter 7. (2) This part does not apply to an audit of pharmacy records when fraud or other intentional and willful misrepresentation is evidenced by the review of claims data, statements, physical […]

33-2-2004. Audit of pharmacy records

33-2-2004. Audit of pharmacy records. (1) An entity conducting an audit of pharmacy records shall audit a pharmacy using the same standards and parameters as used by the entity in auditing other pharmacies on behalf of the same audit client. (2) An audit that involves clinical or professional judgment must be conducted by or in consultation with […]

33-2-2005. Prohibitions — recoupment — payment — interest

33-2-2005. Prohibitions — recoupment — payment — interest. An entity conducting an audit may not: (1) include dispensing fees unless a prescription was not actually dispensed, the prescriber denied authorization, the prescription dispensed was a dispensing error by the pharmacy, or the identified overpayment is based solely on an extra dispensing fee; (2) recoup funds for prescription clerical […]

33-2-2006. Onsite audits — preliminary and final reports — appeals

33-2-2006. Onsite audits — preliminary and final reports — appeals. For audits conducted onsite, the following provisions apply: (1) An entity that audits a pharmacy shall provide the pharmacy with a preliminary audit report, delivered to the pharmacy or its corporate office of record within 60 days after completion of the audit. (2) A pharmacy has 30 days […]