Under South Carolina’s Pharmacy Audit Bill of Rights, a pharmacy has a right: To have at least fourteen days’ advance notice of the initial audit for each audit cycle with no audit to be initiated or scheduled during the first five days of any month without the express consent of the pharmacy; To have a projection of an overpayment or underpayment based on either the number of patients served with a similar diagnosis or the number of similar prescription orders or refills for similar drugs; To be audited under the same standards and parameters as other similarly situated pharmacies audited by the same entity; To have at least thirty days following receipt of the preliminary audit report to produce documentation to address any discrepancy found during an audit. To have the auditing entity to provide the pharmacy, upon request, all records related to the audit in an electronic format or contained in digital media; To be permitted to resubmit a claim subject to an audit (so long as a claim is made within the contractual claim submission time period) in lieu of recoupment; and To have the period covered by an audit limited to 24 months from the date a claim was submitted. The law also sets forth a statutory appeals process, including requirements of written preliminary and final audit findings.

Link to Existing Law: SC Code § 38-71-1810

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.