(a) When a pharmacy benefits manager conducts an audit of a pharmacy, the pharmacy benefits manager shall base the recoupment of overpayments on the actual overpayment of the claim, except as provided in AS 21.27.915(b).
(b) A pharmacy benefits manager conducting an audit of a pharmacy may not
(1) use extrapolation in calculating recoupments or penalties for audits, unless required by state or federal contracts;
(2) assess a charge-back, recoupment, or other penalty against a pharmacy solely because a prescription is mailed or delivered at the request of a patient; or
(3) receive payment
(A) based on a percentage of the amount recovered; or
(B) for errors that have no actual financial harm to the patient or medical plan.
Structure Alaska Statutes
Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers
Article 9. Pharmacy Benefits Managers.
Sec. 21.27.901. Registration of pharmacy benefits managers; scope of business practice.
Sec. 21.27.905. Renewal of registration.
Sec. 21.27.910. Pharmacy audit procedural requirements.
Sec. 21.27.915. Overpayment or underpayment.
Sec. 21.27.925. Pharmacy audit reports.
Sec. 21.27.930. Pharmacy audit appeal; future repayment.
Sec. 21.27.935. Fraudulent activity.
Sec. 21.27.940. Pharmacy audits; restrictions.
Sec. 21.27.945. Drug pricing list; procedural requirements.