Florida HB 1209: Department of Financial Services

Bill Text

HB 1209 2026

CODING: Words stricken are deletions; words underlined are additions.
hb1209-00
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A bill to be entitled 1
An act relating to pharmacy audits; amending s. 2
624.491, F.S.; revising requirements for audits of 3
licensed pharmacies conducted by or on behalf of 4
pharmacy benefit plans or programs; revising audit 5
procedures, documentation requirements, recoupment 6
limits, and reporting and appeal requirements; 7
providing procedures for conducting audits of fraud, 8
waste, or abuse; revising applicability; providing for 9
enforcement; authorizing the Office of Insurance 10
Regulation to impose fines and other administrative 11
penalties; authorizing the suspension or revocation of 12
a pharmacy benefit manager's registration under 13
certain circumstances; requiring the Financial 14
Services Commission to adopt rules; providing an 15
effective date. 16
17
Be It Enacted by the Legislature of the State of Florida: 18
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Section 1. Section 624.491, Florida Statutes, is amended 20
to read: 21
624.491 Pharmacy audits; enforcement; penalties; 22
rulemaking.— 23
(1) A pharmacy benefits plan or program as defined in s. 24
626.8825 providing pharmacy benefits must comply with the 25

HB 1209 2026

CODING: Words stricken are deletions; words underlined are additions.
hb1209-00
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requirements of this section when the pharmacy benefits plan or 26
program or any person or entity acting on behalf of the pharmacy 27
benefits plan or program, including, but not limited to, a 28
pharmacy benefit manager as defined in s. 626.88, audits the 29
records of a pharmacy licensed under chapter 465. The person or 30
entity conducting such audit must: 31
(a) Apply uniform audit standards, scope, frequency, and 32
penalty practices to all pharmacies within the pharmacy benefits 33
plan or program's network, including pharmacy benefit manager-34
owned or affiliated pharmacies and nonaffiliated pharmacies. 35
(b) Not impose stricter audit methodologies, higher error 36
thresholds, expanded documentation requirements, or more 37
frequent audits on nonaffiliated pharmacies than on pharmacy 38
benefit manager-owned or affiliated pharmacies. 39
(c) Upon request by the office or a network pharmacy 40
subject to audit, provide documentation demonstrating compliance 41
with paragraph (a) or paragraph (b), including a comparison of 42
audit frequency, scope, methodologies and recoupment rates 43
between pharmacy benefit manager-owned or affiliated pharmacies 44
and nonaffiliated pharmacies. 45
(d)(a) Except as provided in subsection (5) (3), notify 46
the pharmacy in writing at least 30 7 calendar days before any 47
the initial onsite or remote audit for each audit cycle. 48
(e)(b) Not schedule an onsite audit during the first 7 3 49
calendar days of a month unless the pharmacist consents in 50

HB 1209 2026

CODING: Words stricken are deletions; words underlined are additions.
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writing otherwise. 51
(f) Not disrupt patient care or otherwise interfere with 52
the pharmacy's daily operations. 53
(g)(c) Limit the duration of the audit period to 24 months 54
after the date a claim is submitted to or adjudicated by the 55
entity. 56
(h) Limit each audit to a random sampling of no more than 57
0.1 percent of prescriptions. Additional claims may be audited 58
only if fraud, waste, or abuse is reasonably suspected and 59
stated in writing. 60
(i) Use a random selection process for conducting audits. 61
Targeted selection based on drug class, cost, or therapeutic 62
category is prohibited unless fraud, waste, or abuse is 63
reasonably suspected and stated in writing. 64
(j)(d) In the case of an audit that requires clinical or 65
professional judgment, conduct the audit in consultation with, 66
or allow the audit to be conducted by, a pharmacist licensed in 67
this state. 68
(k)(e) Allow the pharmacy to use the written and 69
verifiable records of a prescriber, hospital, physician, or 70
other authorized practitioner, which are transmitted by any 71
means of communication, to validate the pharmacy records in 72
accordance with state and federal law. Electronic records and 73
scanned prescriptions are valid. 74
(l)(f) Reimburse the pharmacy for a claim that was 75

HB 1209 2026

CODING: Words stricken are deletions; words underlined are additions.
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retroactively denied for a clerical error, typographical error, 76
scrivener's error, or computer error, or an omission or 77
discrepancy in documentation that does not affect the identity 78
of the patient, the identity of the prescriber, the drug 79
dispensed, the quantity dispensed, the date of service, or the 80
accuracy of the amount paid under the claim, if the prescription 81
was properly and corre