{"data":{"id":"us-sd/sdcl-58-29f-6","jurisdiction":"us-sd","citation":"SDCL § 58-29F-6","heading":"Recoupment or chargeback criteria.","body":"For recoupment or chargeback, the following criteria apply:\n(1) Audit parameters shall consider consumer-oriented parameters based on manufacturer listings;\n(2) A pharmacy's usual and customary price for compounded medications is considered the reimbursable cost unless the pricing methodology is outlined in the provider contract;\n(3) A finding of overpayment or underpayment can only be based on the actual overpayment or underpayment and not 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;\n(4) The entity conducting the audit may not use extrapolation in calculating the recoupment or penalties for audits unless required by state or federal law or regulation;\n(5) Calculations of overpayments may not include dispensing fees unless:\n(a) A prescription was not actually dispensed;\n(b) The prescriber denied authorization;\n(c) The prescription dispensed was a medication error by the pharmacy; or\n(d) The identified overpayment is solely based on an extra dispensing fee;\n(6) An entity may not consider any clerical or record-keeping error, such as a typographical error, scrivener's error, or computer error regarding a required document or record as fraud. However, such errors may be subject to recoupment;\n(7) In the case of errors that have no actual financial harm to the patient or plan, the pharmacy benefits manager may not assess any chargebacks. Errors that are a result of the pharmacy's failing to comply with a formal corrective action plan may be subject to recovery; and\n(8) Interest may not accrue during the audit period for either party. The audit period begins with the notice of the audit and ends with the final audit report.","path":["TITLE 58. INSURANCE","CHAPTER 58-29F. PHARMACY AUDIT INTEGRITY PROGRAM"],"source_url":"https://sdlegislature.gov/Statutes/58-29F-6","current_through":"2026-08-31","vintage":"","retrieved_at":"2026-09-03T15:18:57Z","sha256":"00d0bc8262ddf91451e207f40a67741382cf0a17e8aa1629df221556976d02de","source_id":"us-sd","stale":true,"prev":"us-sd/sdcl-58-29f-5","next":"us-sd/sdcl-58-29f-7"},"notice":"GroundRules: Original legal text. Not legal advice."}