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.