Effective until January 1, 2022: The state’s fair audit laws require that PBMs:

● Must establish, in writing, a procedure for a pharmacy to appeal the entity’s findings with respect to a claim and must provide a pharmacy with a notice regarding the procedure, in writing or electronically, prior to conducting an audit of the pharmacy’s claims;

● May not conduct an audit of a claim more than twenty-four months after the date the claim was adjudicated by the entity;

● Must give at least fifteen days’ advance written notice of an on-site audit to the pharmacy or corporate headquarters of the pharmacy;

● May not conduct an on-site audit of more than 250 unique prescriptions of a pharmacy in any twelve-month period except in cases of alleged fraud;

● May not conduct more than one on-site audit of a pharmacy in any twelve-month period;

● Must audit each pharmacy under the same standards and parameters that the entity uses to audit other similarly situated pharmacies; and

● May not recoup costs assocaited with clerical errors or other errors that do not result in financial harm.

The law further prohibits extrapolation, and prohibits PBMs from compensating auditors based on amounts recovered. Finally, the law provides for an appeal framework and timeline.

Link to Existing Law: Wash. Rev. Code Ann. § 19.340.040

This is fairly a substantive audit law. It would be benefited to some degree if it included a statutory private right of action for an aggreived provider.