§ 58-29f-5

58-29F-5. Audit terms.Unless otherwise prohibited by federal statutes or regulations, for any entity conducting a pharmacy audit the following audit items apply:(1)The period covered by the audit may not exceed twenty-four months from the date that the claim was submitted to or adjudicated by the entity, unless a longer period is required under state or federal law;(2)If an entity uses random sampling as a method for selecting a set of claims for examination, the sample size shall be appropriate for a statistically reliable sample. Notwithstanding any other provision, the auditing entity shall provide the pharmacy a masked list that provides a prescription number or date range that the auditing entity is seeking to audit;(3)An on-site audit may not take place during the first five business days of the months of December and January unless the pharmacy consents;(4)An auditor may not enter any portion of the pharmacy area where patient-specific information is available unless escorted, and to the extent possible shall remain out of sight and hearing range of the pharmacy patients;(5)Any recoupment may not be deducted against future remittances until final completion of any appeals

and to the extent possible shall remain out of sight and hearing range of the pharmacy patients;(5)Any recoupment may not be deducted against future remittances until final completion of any appeals process and both parties have received the results of the final audit;(6)A pharmacy benefits manager may not require information to be written on a prescription unless the information is required to be written on the prescription by state or federal law. Recoupment may be assessed for items not written on the prescription if:(a)Additional information is required in the provider manual; or(b)The information is required by the Food and Drug Administration; or(c)The information is required by the drug manufacturer's product safety program; and(d)The information in subsections (a), (b), or (c) is not readily available for the auditor at the time of the audit;(7)The auditing company or agent may not receive payment based on a percentage of the amount recovered. This section does not prevent the entity conducting the audit from charging or assessing the responsible party, directly or indirectly, based on amounts recouped if:(a)The plan sponsor and the entity conducting the audit have a

t the entity conducting the audit from charging or assessing the responsible party, directly or indirectly, based on amounts recouped if:(a)The plan sponsor and the entity conducting the audit have a contract that explicitly states the percentage charge or assessment to the plan sponsor; and(b)A commission to an agent or employee of the entity conducting the audit is not based, directly or indirectly, on amounts recouped. Source: SL 2013, ch 254, §5.