The state’s fair audit law includes requirements such as: an auditing entity conducting a pharmacy audit may not review more than 250 prescriptions in any audit; an auditing entity conducting a pharmacy audit may have access to a pharmacy’s previous audit reports only if the report was prepared by that auditing entity; information collected during a pharmacy audit shall be confidential; the auditing entity conducting a pharmacy audit may not compensate an employee or contractor with which an auditing entity contracts to conduct a pharmacy audit solely based on the amount claimed or the actual amount recouped by the pharmacy being audited; the auditing entity shall provide the pharmacy being audited with at least 14 calendar days’ prior written notice before conducting a pharmacy audit unless both parties agree otherwise; a pharmacy may request a delay of the audit within 72 hours of receiving notice of the audit; the auditing entity shall accept paper or electronic signature logs that document the delivery of prescription or nonproprietary drugs and pharmacist services to a health plan beneficiary or the beneficiary’s caregiver or guardian; prior to leaving the pharmacy after the on-site portion of the pharmacy audit, the auditing entity shall provide to the representative of the pharmacy a complete list of pharmacy records reviewed; and a pharmacy audit that involves clinical judgment shall be conducted by, or in consultation with, a pharmacist. The PBM must also adhere to an audit appeal framework and timeline, allowing the pharmacy to appeal any findings. There is a 24 month look-back period and no extrapolation is allowed.

Link to Existing Law: W. Va. Code Ann. § 33-51-4

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.