Recoupment.

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(a) When a pharmacy benefits manager conducts an audit of a pharmacy, the pharmacy benefits manager shall base the recoupment of overpayments on the actual overpayment of the claim, except as provided in AS 21.27.915(b).

(b) A pharmacy benefits manager conducting an audit of a pharmacy may not

(1) use extrapolation in calculating recoupments or penalties for audits, unless required by state or federal contracts;

(2) assess a charge-back, recoupment, or other penalty against a pharmacy solely because a prescription is mailed or delivered at the request of a patient; or

(3) receive payment

(A) based on a percentage of the amount recovered; or

(B) for errors that have no actual financial harm to the patient or medical plan.


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