California Business and Professions Code CHAPTER 9.5 - Audits of Pharmacy Benefits

  • Section 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 and...
  • Section 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 payer has...
  • Section 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...
  • Section 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...
  • Section 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 course of...
  • Section 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,...
  • Section 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 audit shall make...
  • Section 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,...
  • Section 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 report shall...
  • Section 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...
  • Section 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 pharmacy benefit...

Last modified: October 22, 2018