{"data":{"id":"us-ak/as-21.27.915","jurisdiction":"us-ak","citation":"AS 21.27.915","heading":"Overpayment or underpayment.","body":"(a) When a pharmacy benefits manager conducts an audit of a pharmacy, the pharmacy benefits manager shall base a finding of overpayment or underpayment by the pharmacy on the actual overpayment or underpayment and not on a projection based on the number of patients served having a similar diagnosis or on the number of similar orders or refills for similar drugs, except as provided in (b) of this section.\n(b) A pharmacy benefits manager may resolve a finding of overpayment or underpayment by entering into a settlement agreement with the pharmacy. The settlement agreement\n(1) must comply with the requirements of AS 21.36.125; and\n(2) may be based on a statistically justifiable projection method.\n(c) A pharmacy benefits manager may not include the dispensing fee amount in a finding of an overpayment unless\n(1) a prescription was not actually dispensed;\n(2) the prescriber denied authorization;\n(3) the prescription dispensed was a medication error by the pharmacy; or\n(4) the identified overpayment is solely based on an extra dispensing fee.","path":["Title 21. Insurance.","Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers.","Article 9. Pharmacy Benefits Managers."],"source_url":"https://www.akleg.gov/basis/statutes.asp#21.27.915","current_through":"Alaska Statutes 2025 (34th Legislature, 2025-2026)","vintage":"","retrieved_at":"2026-09-02T06:17:40Z","sha256":"ee5ac2959bebe7759d2378978b1bd8beb814630f188e7bb23e7a7a53e72543d4","source_id":"us-ak","stale":false,"prev":"us-ak/as-21.27.910","next":"us-ak/as-21.27.920"},"notice":"GroundRules: Original legal text. Not legal advice."}