GroundRules
AS 21.27.920: Recoupment.
Where this section sits in the code
- Title 21. Insurance.
- Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers.
- Article 9. Pharmacy Benefits Managers.
(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.
Collected 2026-09-02T06:17:40Z. Source file · JSON