§ 25-26-22-5 — Audit requirements

Indiana § 25-26-22-5

• Jurisdiction: Indiana
• Title 25: PROFESSIONS AND OCCUPATIONS
• Art. 26: PHARMACISTS, PHARMACIES, DRUG STORES
• Ch. 22: Pharmacy Audits

Text

An auditor conducting an audit shall comply
with all of the following:
(1) The contract under which the audit is performed must provide
a description of audit procedures that will be followed.
(2) For an onsite audit conducted at a pharmacy's location, the
auditor that conducts the audit shall provide written notice to the
pharmacy at least two (2) weeks before the initial onsite audit is
performed for each audit cycle.
(3) The auditor shall not interfere with the delivery of pharmacist
services to a patient and shall use every effort to minimize
inconvenience and disruption to pharmacy operations during the
audit. This subdivision does not prohibit audits during normal
business hours of the pharmacy.
(4) If the audit requires use of clinical or professional judgment,
the audit must be conducted by or in consultation with a licensed
pharmacist.
(5) The auditor shall allow the use of written or otherwise
transmitted hospital, physician, or other health practitioner
records to validate a pharmacy record with respect to a
prescription for a legend drug.
(6) The auditor shall perform the audit according to the same
standards and parameters that the auditor uses to audit all other
similarly situated pharmacies on behalf of the third party payer.
(7) The period covered by the audit must not exceed twenty-four
(24) months after the date on which the claim that is the subject
of the audit was submitted to or adjudicated by the third party
payer, and the pharmacy must be permitted to resubmit
electronically any claims disputed by the audit. This subdivision
does not limit the period for audits under the Medicaid program
that are conducted due to a federal requirement.
(8) The audit must not be initiated or scheduled during the first
seven (7) calendar days of any month without the voluntary
consent of the pharmacy. The consent may not be mandated by a
contract or any other means.
(9) Payment to the onsite auditor for conducting the audit must
not be based on a percentage of any amount recovered as a result
of the audit.
(10) Within twenty-four (24) hours of receiving the notice of an
audit, a pharmacy may reschedule the audit to a date not more
than fourteen (14) days after the date proposed by the auditor.
However, if the auditor is unable to reschedule within the fourteen
(14) day period, the auditor shall select and reschedule the audit
for a date after the fourteen (14) day period.
(11) This subdivision does not apply to an audit conducted by the
Medicaid program. If a clerical error is identified by the auditor
during the course of an audit, the auditor shall allow the pharmacy
to obtain a prescription that corrects the clerical error from the
prescribing physician. However, if the clerical error results in an
overpayment to the pharmacy, the overpayment may be recouped
by the third party payer.

Legislative History

As added by P.L.7-2009, SEC.1. Amended by P.L.159-2012, SEC.10.