SB483 Alabama 2015 Session

Summary

Primary Sponsor

Del Marsh

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.

Summary

SB483 tightens oversight of pharmacy benefit managers and audits in Alabama, adds pricing and access protections, and strengthens pharmacist and patient protections.

What This Bill Does

It extends Chapter 45 to apply to pharmacy benefit managers, adding rules for administering pharmaceutical coverage, including how changes are communicated, how reimbursement works, and patient care protections. It strengthens the Pharmacy Audit Integrity Act with clearer audit procedures, confidentiality, and rules on documentation, overpayments, and claim adjudication. It establishes pricing transparency and management for MAC pricing, requires disclosures to contracting pharmacies, and sets safeguards to protect pharmacists’ professional independence and patients’ ability to choose their pharmacy, plus provisions for 90-day drug supplies and medication synchronization.

Who It Affects

• Pharmacy benefit managers (PBMs), health plans, insurers, and other contracted entities, who would face new disclosure, pricing, audit, reporting, and enforcement requirements.
• Pharmacists, pharmacies, and patients, who gain protections for choosing any licensed local pharmacy, fair reimbursement processes, 90-day prescription options, synchronization of medications, and a clearer audit/dispute framework.

Key Provisions

• Adds Article 3 to Chapter 45 (Sections 27-45-30 to 27-45-38) detailing administration of pharmaceutical coverage, including 30-day advance notice of changes to terms, reimbursement terms, dispute resolution, and audit appeals.
• Requires PBM contracts to disclose reimbursement method, payment timing, eligibility verification, dispute resolution, and formularies; mandates 30-day notice before cancellation of benefits; and requires notice to enrollees when programs are terminated.
• Prohibits PBMs from denying pharmacist participation, mandating network participation, auto-enrolling or disenrolling pharmacies, or using discount networks to force participation; protects professional independence and prohibits therapeutic interference.
• Imposes MAC pricing rules: define MAC using FDA-equivalent drugs, require multiple data sources, provide weekly MAC updates, and allow pharmacies to contest MAC rates with a defined appeal process.
• Requires 90-day supplies at network pharmacies and allows prorated cost-sharing for shorter fills when justified for synchronization or chronic care; prohibits certain fee structures tied to days’ supply.
• Enhances audit procedures (Section 34-23-184): advance notice for audits, on-site audit conduct with pharmacist presence, audits led by licensed pharmacists, allowances for clerical error corrections without fraud findings, and strict timelines for preliminary and final audit reports.
• Delimits recoupment timelines and requires final disposition before recoupment; prohibits interest during the audit; ensures confidentiality of audit information and limits cross-use of audit data between payers.
• Authorizes penalties for willful violations and designates enforcement authority to the Commissioner of Insurance; requires rules to implement the article and related sections.

AI-generated summary using openai/gpt-5-nano on Feb 24, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Pharmacies and Pharmacists