Alaska Statutes: AS 21.27.915. Overpayment or Underpayment.

Alaska Statutes. Title 21. Insurance Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers Section 915. Overpayment or Underpayment.

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AS 21.27.915. Overpayment or Underpayment.

   (a) When a pharmacy benefits manager conducts an audit of a pharmacy, the pharmacy benefits manager shall base a finding of overpayment or underpayment by the pharmacy on the actual overpayment or underpayment and not on a projection based on the number of patients served having a similar diagnosis or on the number of similar orders or refills for similar drugs, except as provided in (b) of this section.
   (b) A pharmacy benefits manager may resolve a finding of overpayment or underpayment by entering into a settlement agreement with the pharmacy. The settlement agreement
        (1) must comply with the requirements of AS 21.36.125; and
        (2) may be based on a statistically justifiable projection method.
   (c) A pharmacy benefits manager may not include the dispensing fee amount in a finding of an overpayment unless
        (1) a prescription was not actually dispensed;
        (2) the prescriber denied authorization;
        (3) the prescription dispensed was a medication error by the pharmacy; or
        (4) the identified overpayment is solely based on an extra dispensing fee.

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