CHAPTER 9.5. Audits of Pharmacy Benefits [4430. - 4441.]
Chapter 9.5 added by Stats. 2012, Ch. 706, Sec. 1.
§§ 4430–4441 · 12 sections
- § 4430 For purposes of this chapter, the following definitions shall apply: (a) “Carrier” means a health care service plan, as defined in Section 1345 of the Health…
- § 4431 (a) Nothing in this chapter shall apply to an audit conducted because a pharmacy benefit manager, carrier, health benefit plan sponsor, or other third-party…
- § 4432 Notwithstanding any other law, a contract that is issued, amended, or renewed on or after January 1, 2013, between a pharmacy and a carrier or a pharmacy…
- § 4433 (a) An entity conducting a pharmacy audit shall not receive payment or any other consideration on any basis that is tied to the amount claimed or actual amount…
- § 4434 (a) Except as otherwise prohibited by state or federal law, an entity conducting a pharmacy audit shall keep confidential any information collected during the…
- § 4435 (a) An entity conducting an onsite pharmacy audit shall not initiate or schedule a pharmacy audit during the first five business days of any calendar month,…
- § 4436 (a) A pharmacy audit that involves clinical judgment shall be conducted by, or in consultation with, a licensed pharmacist. (b) An entity conducting a pharmacy…
- § 4437 The time period covered by a pharmacy audit shall not exceed 24 months from the date that the claim was submitted to, or adjudicated by, the pharmacy benefits…
- § 4438 (a) (1) An entity conducting a pharmacy audit shall deliver a preliminary audit report to the pharmacy before issuing a final audit report. This preliminary…
- § 4439 This chapter shall not be construed to suggest or imply that the Department of Consumer Affairs or the California State Board of Pharmacy has any jurisdiction…
- § 4440 (a) A pharmacy benefit manager that reimburses a contracting pharmacy for a drug on a maximum allowable cost basis shall comply with this section. (b) A…
- § 4441 (a) For purposes of this section, the following definitions shall apply: (1) “Labeler” means a person or entity that receives prescription drugs from a…