An entity conducting a pharmacy audit shall conform to the following rules:

● An auditing entity shall provide the pharmacy being audited with at least 14 calendar days’ prior written notice before conducting a pharmacy audit, and a pharmacy may request a delay of the audit by providing notice within 72 hours of receiving notice of the audit.

● Prior to leaving an audit, the auditor must produce a complete list of all pharmacy records reviewed.

● A pharmacy audit involving clinical judgment shall be conducted by or in consultation with a pharmacist.

● A pharmacy audit may not cover a period of more than 24 months after the date a claim was submitted by the pharmacy or more than 250 prescriptions.

● The auditing entity may not use extrapolation to calculate penalties or amounts to be charged back or recouped.

● An auditing entity may have access to a pharmacy’s previous audit report only if the report was prepared by that auditing entity, and information collected during a pharmacy audit shall be confidential

● An auditor may not be compensated based solely on the amount claimed or the actual amount recouped by the pharmacy being audited.

An auditing entity shall provide the pharmacy with a written report of the pharmacy audit and comply with a statutory audit appeal framework and timeline, and may not recoup monies pending adjudication of an appeal (unless identified discrepancies exceed $25,000). These requirements do not apply to an investigative audit of pharmacy records when fraud, waste, abuse or other intentional misconduct is indicated by physical review or review of claims data or statements.

Link to Existing Law: PA ST 40 P.S. § 4511

This is a fairly comprehensive fair audit law. It would be benefited to some degree if it included a statutory private right of action for an aggreived provider and if it included language prohibiting recoupment in instances of clerical errors or where there is not financial harm.