The state’s fair audit law includes requirements such as: _ PBM must provide written notice to the pharmacy at least 2 weeks before conducting the initial onsite audit for each audit cycle; _ PBM must employ the services of a pharmacist if the audit requires the clinical or professional judgment of a pharmacist; _ PBM may only permit its auditors to enter the prescription area of a pharmacy only when accompanied by or authorized by a member of the pharmacy staff; _ PBM must allow a pharmacist or pharmacy to use any prescription, or authorized change to a prescription to validate claims submitted for reimbursement, as well as the records of a hospital or a physician or other prescriber authorized by law; _ PBM must audit each pharmacy and pharmacist under the same standards and parameters as other similarly situated pharmacies or pharmacists audited by the PBM; _ PBM must only audit claims submitted or adjudicated within the 2–year period immediately preceding the audit; _ PBM may not disrupt the provision of services to the customers of a pharmacy during an audit; _ PBM may not use the accounting practice of extrapolation to calculate overpayments or underpayments; _ PBM may not share audit information with another PBM or use information from an audit conducted by another PBM; and _ PBM may not recoup by setoff any moneys for an overpayment or denial of a claim until the pharmacy or pharmacist has an opportunity to review and fully appeal the pharmacy benefits manager’s findings. The law further requires PBMs to establish audit appeal timelines and frameworks, including the issuance of preliminary and final audit findings.

Link to Existing Law: Md. Code Ann., Ins. § 15-1629

While this is fairly a substantive audit law, there is no provision limiting the number of claims to be audited, and it would be benefited to some degree if it included a statutory private right of action for an aggreived provider. It could also benefit from language prohibiting recoupment when there has not been any financial harm.