SB348 Alabama 2018 Session

Summary

Primary Sponsor

William “Bill” M. BeasleySenator

Democrat

Session

Regular Session 2018

Title

Pharmacies, pharmacy records, auditing procedures, further provided for, recoupment limited under certain conditions, Secs. 34-23-181, 34-23-184, 34-23-185, 34-23-186 am'd.

Summary

SB 348 tightens pharmacy audit rules and limits recoupment for certain clerical errors.

What This Bill Does

It rewrites audit procedures for pharmacy records and adds protections for pharmacies against overzealous recoupment. It limits recoupment to actual overpayments, allows corrected claims for clerical errors, requires audits to be conducted with a licensed pharmacist for clinical reviews, and sets clear timelines and reporting rules. It also bans extrapolation when calculating penalties, caps audit sample sizes, and creates an appeals process with mediation, plus requires the costs and procedures to be fair to pharmacies and plans.

Who It Affects

• Pharmacies and pharmacists: new audit procedures, limits on recoupment for clerical errors, and rights to appeal and correct errors
• PBMs, health plans/insurers, and Medicaid: must follow stricter audit rules, limit sample size, control costs, and prohibit extrapolated penalties

Key Provisions

• Defines key terms (Health Benefit Plan, Pharmacy, PBM, Pharmacist Services) for audits
• Auditing procedures: two-week notice, checklists, material disclosure, non-interference with patient care, licensed pharmacist involvement for clinical reviews
• Clerical errors: not fraud; can amend claims; no criminal penalties without fraud proof; recoupment limited to actual overpayment; misfill and dispensing fees treated carefully
• Audit scope and costs: sample size capped at 150 prescriptions; costs borne by the auditing entity; period not more than two years; no audits in first five days; reports and timelines for preliminary/final findings
• Appeals and mediation: written appeal process, possible mediation, mediator from Alabama Supreme Court list
• Prohibition of extrapolation: no extrapolation to calculate recoupments or penalties; no compensation based on amount recovered
• Effective date: law takes effect the first day of the third month after passage

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