SB483 Alabama 2015 Session

Summary

Primary Sponsor

Del Marsh Senator

Republican

Session

Regular Session 2015

Title

Pharmacy audit procedures, Pharmacy Audit Integrity Act, audit procedures altered, amended claims, overpayments, records required by federal or state law, confidentiality of audit info, appeals, Secs. 27-45-30 to 27-45-38, inclusive, added; Secs. 27-45-1 to 27-45-9, inclusive, 34-23-184 am'd.

Description

This bill would amend the Pharmaceutical Insurance Coverage Chapter of the Alabama Insurance Code to provide further for the applicability of Chapter 45 of Title 27, Code of Alabama, to pharmacy benefit management administered by various health care plans, companies, and facilities; to provide for definitions, choice of pharmacy services, and contracting providers, void policies, non-mandated benefits and services; requirements of compliance; nonconforming policies; duty of Insurance Department to enforce, adoption of rules, regulated activities; and violations.

This bill would add a new Article 3 to Chapter 45 of Title 27, Code of Alabama, relating to the administration of pharmaceutical insurance coverage, including timely notice of changes in terms of managers; reimbursement and payment; cancellation procedures; denial of payment; preservation of patient care; use of pharmacy data; pricing of drugs; 90-day supply at retail; and synchronization of medication.

This bill would amend the Pharmacy Audit Integrity Act to provide further for audit procedures and reports regarding disclosure to a pharmacy prior to changes in contract or audit procedures; extension of time for producing audit items; qualifications of licensed pharmacists giving professional judgment; amended claims; requirements for documentation; confidentiality and limits on audit information; validation of pharmacy records for changes of certain drugs authorized by federal or state law; overpayments and recoupment of excess payments; and claims adjudication.

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Subjects

Pharmacies and Pharmacists