Alaska Statutes: AS 21.27.910. Pharmacy Audit Procedural Requirements.

Alaska Statutes. Title 21. Insurance Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers Section 910. Pharmacy Audit Procedural Requirements.

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AS 21.27.910. Pharmacy Audit Procedural Requirements.

   (a) When a pharmacy benefits manager conducts an audit of the records of a pharmacy, the period covered by the audit of a claim may not exceed two years from the date that the claim was submitted to or adjudicated by the pharmacy benefits manager, whichever is earlier. Except as required under AS 21.36.495, a claim submitted to or adjudicated by a pharmacy benefits manager does not accrue interest during the audit period.
   (b) A pharmacy benefits manager conducting an on-site audit shall give the pharmacy written notice of at least 10 business days before conducting an initial audit.
   (c) A pharmacy benefits manager may not conduct
        (1) an audit during the first seven calendar days of any month unless agreed to by the pharmacy;
        (2) more than one on-site audit of a pharmacy within a 12-month period; or
        (3) on-site audits of more than 250 separate prescriptions at one pharmacy within a 12-month period unless fraud by the pharmacy or an employee of the pharmacy is alleged.
   (d) If an audit involves clinical or professional judgment, the individual conducting the audit must
        (1) be a pharmacist who is licensed and in good standing under AS 08.80; or
        (2) conduct the audit in consultation with a pharmacist who is licensed and in good standing under AS 08.80.
   (e) A pharmacy, in responding to an audit, may use
        (1) verifiable statements or records, including medication administration records of a nursing home, assisted living facility, hospital, physician, or other authorized practitioner, to validate the pharmacy record;
        (2) a legal prescription to validate claims in connection with prescriptions, refills, or changes in prescriptions, including medication administration records, prescriptions transmitted by facsimile, electronic prescriptions, or documented telephone calls from the prescriber or the prescriber's agent.
   (f) A pharmacy benefits manager shall audit each pharmacy under the same standards and parameters as other similarly situated pharmacies in a network pharmacy contract in this state.

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