173.732 Audit of pharmacy benefit manager supplier contracts.

(A) To determine whether the pharmacy benefit manager selected under section 173.731 of the Revised Code to serve as the Ohio’s best Rx program’s consulting pharmacy benefit manager has provided valid information when providing drug pricing verification services under section 173.742 of the Revised Code or drug manufacturer payment verification services under section 173.814 of the Revised Code, the department of aging may request that the consulting pharmacy benefit manager provide for an audit of its relevant contracts with drug manufacturers and terminal distributors of dangerous drugs.

In making audit requests under this section, both of the following apply:

(1) The department may request an audit on a regularly occurring basis, but not more frequently than once every three years.

(2) The department may request an audit at any time it has a reasonable basis to believe that the consulting pharmacy benefit manager is not acting in good faith in providing drug pricing verification services or drug manufacturer payment verification services. Notice of the request shall be made in writing and signed by the director of aging. The notice may specify the basis for the belief that the consulting pharmacy benefit manager is not acting in good faith. If the basis for the belief is not specified and the audit findings demonstrate that the consulting pharmacy benefit manager acted in good faith, the department shall pay the cost incurred by the consulting pharmacy benefit manager in providing for the audit.

(B) An audit provided for under this section shall be performed only by an auditor that is mutually satisfactory to the department and consulting pharmacy benefit manager and independent of both the department and consulting pharmacy benefit manager.

(C) If the findings of an audit provided for under this section demonstrate that the verification services provided by the consulting pharmacy benefit manager did not result in valid information, the department shall use the audit findings for purposes of confirming the validity of the one or more drug pricing formulas designated under section 173.741 of the Revised Code and entering into agreements with drug manufacturers under section 173.81 of the Revised Code.

Effective Date: 07-01-2007