S.F. No. 973 establishes procedures that must be followed during pharmacy audits.
Section 1 (151.60) states that the pharmacy audit integrity program is established to provide standards for an audit of pharmacy records.
Section 2 (151.61) defines the following terms: “entity,” “pharmacy benefits manager or PBM,” and “plan sponsor.”
Section 3 (151.63) specifies procedures that must be followed by any entity conducting a pharmacy audit.
Section 4 (151.64) specifies the criteria for recoupment or chargeback to occur.
Section 5 (151.65) authorizes that any legal prescription may be used to validate claims.
Section 6 (151.66) requires the entity conducting the audit to establish a written appeals process that includes appeals of preliminary and final reports. Either party may seek mediation.
Section 7 (151.67) requires preliminary audit reports to be delivered to the pharmacy within 30 days of conclusion of the audit. The final audit must be delivered to the pharmacy within 90 days of receipt of the preliminary audit report or final appeal. Chargebacks, recoupment, or other penalties may not be assessed until the appeals process has been exhausted and the final report issued. An entity must remit money related to under payments within 30 days after appeals process has been exhausted and the final report issued. Unless superseded by state or federal law audit information may not be shared. Auditors may have access to previous audit reports of a pharmacy only if conducted by the same auditing entity.
Section 8 (151.68) requires an auditing entity to provide a copy of the final report to the plan sponsor whose claims were included in the audit, and to return any recouped money to the plan sponsor.
Section 9 (151.69) states that Minnesota Statutes, sections 151.60 to 151.68, do not apply to any investigative audit that involves fraud, willful misrepresentation, or abuse or any audit completed by Minnesota health care programs.
Section 10 establishes an effective date.