58-29E-13. Certain claims adjustments prohibited.

A pharmacy benefit manager may not, directly or indirectly, retroactively adjust a claim for reimbursement submitted by a pharmacy for a prescription drug, unless:

(1)    The adjustment is necessitated by a pharmacy audit conducted in accordance with chapter 58-29F;

(2)    The adjustment is necessitated by a technical billing error;

(3)    The original claim was found to have been fraudulently submitted; or

(4)    The claim submission was a duplicate for which the pharmacy had already received payment.

Source: SL 2019, ch 213, § 2; SL 2023, ch 166, § 13.