For onsite audits conducted by a pharmacy benefit manager:
● A finding of overpayment or underpayment must be based on the actual overpayment or underpayment
● The auditor may not use extrapolation in calculating recoupments or penalties.
● Each entity conducting an audit shall establish an appeals process
● Prior to an audit, the entity conducting an audit shall give the pharmacy 30 days’ advance written notice of the audit, and the range of prescription numbers and the range of dates included in the audit. Additionally, the number of prescriptions shall not exceed 100 selected prescription claims which also includes all associated refills. Signature logs shall not exceed 25
● A pharmacy has the right to request mediation by a private mediator, agreed upon by the pharmacy and the pharmacy benefits manager, to resolve any disagreements.
● A preliminary audit report must be delivered to the pharmacy within 15 days after the conclusion of the audit.
● A pharmacy must be allowed at least 30 days following receipt of the preliminary audit to provide documentation to address any discrepancy found in the audit. A final audit report must be delivered to the pharmacy within 60 days after receipt of the preliminary audit report or final appeal, whichever is later. A charge-back, recoupment or other penalty may not be assessed until the appeal process has been exhausted and the final report issued
● Contracted auditors cannot be paid based on the findings within an audit.
● Any clerical error, typographical error, scrivener’s error or computer error regarding a document or record required under the Medicaid program does not constitute a willful violation
● The period covered by an audit may not exceed two year.
● This section does not apply to any audit, review or investigation that is initiated based on or involving suspected or alleged fraud, willful misrepresentation or abuse.

Link to Exsisting Law: RI ST § 5-19.1-35

This is fairly strong and specific legislation on PBM audits, including very specific limitations on the the number of claims a PBM could select for review at any one time.