§4350-C. Access to records; audits

(CONTAINS TEXT WITH VARYING EFFECTIVE DATES)

(WHOLE SECTION TEXT EFFECTIVE 1/1/20)

1.  Requirements; record keeping.  A carrier shall maintain and have the ability to access all data related to the administration and provision of prescription drug benefits under a health plan of a carrier, including, but not limited to:

A. The names, addresses, member identification numbers, protected health information and other personal information of covered persons; and   [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

B. All contracts, documentation and records, including transaction and pricing data, related to the dispensing of prescription drugs to covered persons under the health plan.   [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

2.  Compliance with federal law.  A sale or transaction involving the transfer of any records, information or data described in subsection 1 must comply with the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104‑191 and the federal Health Information Technology for Economic and Clinical Health Act, Public Law 111‑5 and any regulations adopted pursuant to those laws.

[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

3.  Audit records.  A carrier may audit all transaction records related to the dispensing of prescription drugs to covered persons under a health plan of the carrier. A carrier may conduct audits at a location of its choosing and with an auditor of its choosing.

[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

4.  Maintenance of records.  A carrier shall maintain all records, information and data described in subsection 1 and all audit records described in subsection 3 for a period of no less than 5 years.

[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

5.  Authority of superintendent.  Upon request, a carrier shall provide to the superintendent any records, contracts, documents or data held by the carrier or the carrier's pharmacy benefits manager for inspection, examination or audit purposes.

[PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

SECTION HISTORY

PL 2019, c. 469, §8 (NEW). PL 2019, c. 469, §9 (AFF).