Florida SB 1256: Search of the Content, Information, and Communications of Cellular Phones, Portable Electronic Communication Devices, and Microphone-enabled Household Devices

Bill Text

1256 
Pharmacy Audits 
2026-01-06T11:14:05Z 
Revising requirements for audits of licensed pharmacies conducted by or on behalf of pharmacy benefit plans or programs; revising audit procedures, documentation requirements, reporting and appeal requirements, and recoupment limits and procedures; authorizing the Office of Insurance Regulation to investigate complaints of violations, issue cease and desist orders, impose fines and other administrative penalties, order restitution for improper recoupments, prohibit any person or entity from conducting audits for a specified timeframe upon certain findings, and suspend or revoke a pharmacy benefit manager’s registration under certain circumstances, etc. 
Original Filed Version 
2026 
S 
2026-07-01T00:00:00Z 
GB 
General Bill 
__ 

 Florida Senate - 2026 SB 1256 

 By Senator Grall 

 29-01367A-26 20261256__ 
 1 A bill to be entitled 
 2 An act relating to pharmacy audits; amending s. 
 3 624.491, F.S.; revising requirements for audits of 
 4 licensed pharmacies conducted by or on behalf of 
 5 pharmacy benefit plans or programs; revising audit 
 6 procedures, documentation requirements, reporting and 
 7 appeal requirements, and recoupment limits and 
 8 procedures; prohibiting the person or entity 
 9 conducting such audit from taking certain actions; 
 10 requiring that an audit designated as a fraud, waste, 
 11 or abuse audit be based on specified evidence or 
 12 credible allegations or claims; providing requirements 
 13 for the person or entity conducting such fraud, waste, 
 14 or abuse audit; prohibiting a person or entity 
 15 auditing the records of a licensed pharmacy from using 
 16 a fraud, waste, or abuse audit designation to 
 17 circumvent certain provisions; providing an exception; 
 18 revising applicability; providing for enforcement; 
 19 authorizing the Office of Insurance Regulation to 
 20 investigate complaints of violations, issue cease and 
 21 desist orders, impose fines and other administrative 
 22 penalties, order restitution for improper recoupments, 
 23 prohibit any person or entity from conducting audits 
 24 for a specified timeframe upon certain findings, and 
 25 suspend or revoke a pharmacy benefit manager’s 
 26 registration under certain circumstances; requiring 
 27 the Financial Services Commission to adopt rules; 
 28 providing an effective date. 
 29 
 30 Be It Enacted by the Legislature of the State of Florida: 
 31 
 32 Section 1. Section 624.491, Florida Statutes, is amended to 
 33 read: 
 34 624.491 Pharmacy audits; enforcement; penalties; 
 35 rulemaking.— 
 36 (1) A pharmacy benefits plan or program as defined in s. 
 37 626.8825 providing pharmacy benefits must comply with the 
 38 requirements of this section when the pharmacy benefits plan or 
 39 program or any person or entity acting on behalf of the pharmacy 
 40 benefits plan or program, including, but not limited to, a 
 41 pharmacy benefit manager as defined in s. 626.88, audits the 
 42 records of a pharmacy licensed under chapter 465. The person or 
 43 entity conducting such audit must: 
 44 (a) Apply uniform audit standards, scope, frequency, and 
 45 penalty practices to all pharmacies within the pharmacy benefits 
 46 plan’s or program’s network, including pharmacy benefit manager 
 47 owned or -affiliated pharmacies and nonaffiliated pharmacies. 
 48 (b) Not impose stricter audit methodologies, higher error 
 49 thresholds, expanded documentation requirements, or more 
 50 frequent audits on nonaffiliated pharmacies than on pharmacy 
 51 benefit manager-owned or -affiliated pharmacies. 
 52 (c) Upon request by the office or a network pharmacy 
 53 subject to audit, provide documentation demonstrating compliance 
 54 with paragraph (a) or paragraph (b), including a comparison of 
 55 audit frequency, scope, methodologies, and recoupment rates 
 56 between pharmacy benefit manager-owned or -affiliated pharmacies 
 57 and nonaffiliated pharmacies. 
 58 (d)(a) Except as provided in subsection (5) (3), notify the 
 59 pharmacy in writing at least 30 7 calendar days before any the 
 60 initial onsite or remote audit for each audit cycle. 
 61 (e)(b) Not schedule an onsite audit during the first 7 3 
 62 calendar days of a month unless the pharmacist consents in 
 63 writing otherwise. 
 64 (f) Not disrupt patient care or otherwise interfere with 
 65 the pharmacy’s daily operations. 
 66 (g)(c) Limit the duration of the audit period to 24 months 
 67 after the date a claim is submitted to or adjudicated by the 
 68 entity. 
 69 (h) Limit each audit to a random sampling of no more than 
 70 0.1 percent of prescriptions. Additional claims may be audited 
 71 only if fraud, waste, or abuse is reasonably suspected and 
 72 stated in writing. 
 73 (i) Use a random selection process for conducting audits. 
 74 Targeted selection based on drug class, cost, or therapeutic 
 75 category is prohibited unless fraud, waste, or abuse is 
 76 reasonably suspected and