(a) A pharmacy benefits manager conducting an audit shall establish a written appeals process.
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Terms Used In Alaska Statutes 21.27.930

  • Contract: A legal written agreement that becomes binding when signed.
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
(b) Recoupment of disputed funds or repayment of funds to the pharmacy benefits manager by the pharmacy, if permitted by contract, shall occur, to the extent demonstrated or documented in the pharmacy audit findings, after final internal disposition of the audit, including the appeals process. If the identified discrepancy for an individual audit exceeds $15,000, future payments to the pharmacy may be withheld pending finalization of the audit.
(c) A pharmacy benefits manager may not assess against a pharmacy a charge-back, recoupment, or other penalty until the pharmacy benefits manager’s appeals process has been exhausted and the final report or settlement agreement issued.
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