Bill > H1209

This bill revises the requirements for audits of licensed pharmacies conducted by or on behalf of pharmacy benefit plans or programs, which are entities that provide prescription drug coverage. Key changes include requiring uniform audit standards and practices for all pharmacies, prohibiting stricter audit methodologies for non-affiliated pharmacies compared to those owned by pharmacy benefit managers (PBMs), and mandating that PBMs provide documentation of this uniformity upon request. The bill also extends the advance notice period for audits to 30 days, limits audit periods to 24 months, restricts random sampling to no more than 0.1 percent of prescriptions unless fraud is suspected, and allows pharmacies more time to respond to preliminary audit findings. It clarifies that clerical or minor errors are not considered fraud unless intent to defraud is proven, and limits recoupment of funds to dispensing fees unless fraud is established, prohibiting recoupment until appeals are resolved and a final report is issued. Furthermore, the bill outlines specific procedures for fraud, waste, or abuse audits, prohibits certain audit practices like disregarding legally acquired inventory or requiring unnecessary documentation, and grants the Office of Insurance Regulation the authority to investigate violations, impose fines, order restitution, and potentially suspend or revoke a PBM's registration for repeated or willful violations, with the Financial Services Commission tasked with adopting necessary rules.

Health and Social Services

https://www.flsenate.gov/Session/Bill/2026/1209