The state’s fair audit laws require that PBMs: _ Must provide the pharmacy 10 days advanced written notice of the audit and the range of prescription numbers or a date range included in the audit, and may not audit a pharmacy during the first five business days of the month. _ Must not audit claims submitted more than 18 months prior to the audit, or exceed 200 selected prescription claims. _ May only have access to previous audit reports on a particular pharmacy if the previous audit was conducted by the same entity except as required for compliance with state or federal law. _ Must establish an appeals process. _ Must not recoup funds for prescription clerical or recordkeeping errors, including typographical errors, scrivener’s errors, and computer errors on a required document or record unless the audit entity is alleging fraud or other intentional or willful misrepresentation and the audit entity has evidence that the pharmacy’s actions reasonably indicate fraud or intentional and willful misrepresentation.

Link to Existing Law: Utah Code Ann. 58-17b-622

While this is fairly a substantive audit law, there is no provision exempting extrapolation, and it would be benefited to some degree if it included a statutory private right of action for an aggreived provider. However, it does have strong language prohibiting recoupment when there has not been any financial harm.