58-29E-7. Annual audit of pharmacy benefit manager authorized.

A third-party payor that has contracted with a licensed pharmacy benefit manager may audit the pharmacy benefit manager once each calendar year. The audit authorized by this section is in addition to any other statutory or contractual audit rights. As part of the audit, a third-party payor may request:

(1)    All reimbursements paid to retail pharmacies, on a claim level, for all customers of the pharmacy benefit manager in this state, including ancillary charges, claw backs, dispensing fees, drug-specific reimbursements, other fees, rebates, and reimbursement adjustments;

(2)    Differences in reimbursement amounts paid to affiliated and unaffiliated pharmacies, including differences in dispensing fees and reimbursed ingredient costs;

(3)    Historical claims data, including:

(a)    Acquisition costs;

(b)    Administrative fees associated with claims;

(c)    Amounts paid by a covered individual;

(d)    Amounts paid by a third-party payor;

(e)    Channels, whether mail or retail;

(f)    Dispensing fees;

(g)    Formulary tiers;

(h)    Ingredient costs;

(i)    Ingredient quantity;

(j)    Sales tax;

(k)    Supply availability by the number of days; and

(l)    Usual and customary prices; and

(4)    Aggregate rebate amounts, received by calendar quarter, directly or indirectly from manufacturers, including rebates from other entities affiliated with or related to the pharmacy benefit manager, if those entities negotiate or contract with manufacturers.

A pharmacy benefit manager shall, within thirty days, provide the information requested in accordance with this section, together with a certification, signed by the chief executive officer or the chief financial officer of the pharmacy benefit manager, attesting to the accuracy and completeness of the information.

Source: SL 2004, ch 311, § 7; SL 2023, ch 166, § 7.