(a) When a pharmacy benefits manager conducts an audit of a pharmacy, the pharmacy benefits manager shall base a finding of overpayment or underpayment by the pharmacy on the actual overpayment or underpayment and not on a projection based on the number of patients served having a similar diagnosis or on the number of similar orders or refills for similar drugs, except as provided in (b) of this section.
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Terms Used In Alaska Statutes 21.27.915

  • 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) A pharmacy benefits manager may resolve a finding of overpayment or underpayment by entering into a settlement agreement with the pharmacy. The settlement agreement

(1) must comply with the requirements of Alaska Stat. § 21.36.125; and
(2) may be based on a statistically justifiable projection method.
(c) A pharmacy benefits manager may not include the dispensing fee amount in a finding of an overpayment unless

(1) a prescription was not actually dispensed;
(2) the prescriber denied authorization;
(3) the prescription dispensed was a medication error by the pharmacy; or
(4) the identified overpayment is solely based on an extra dispensing fee.
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